Drug Database Form
   
Complete this online form, or download a PDF form, to submit a new entry for the drug database.
Please include images of the pill front and back, and package barcode, as applicable.
    
Contact Information
Account
 
Customer Number (four- or five-digit number)
 
Email
 
First Name
 
Last Name
 
Phone
 
   
Drug Data
Product Code (ex. NDC) as it appears on drug package
 
Drug Barcode/UPC as it appears on drug package
 
Brand Name (if not brand name, enter "N/A")
 
Generic Name
 
Strength and Unit
 
Dosage Form
 
Distributor
 
Package Quantity and Unit
 
Package Type
 
Is Product Tab or Cap (Yes or No)
 
PL
 International Use Only
EU
 International Use Only
   
Tab/Cap Description
Shape
  
Color
 
Color Pattern
 
Scoring
 
Markings - Side A (front)
 If no markings, enter "No Markings"
Markings - Side B (back)
 If not markings, enter "No Markings"