STANDING ORDER CERTIFICATION FORM - …
EPI-2016-0316 STANDING ORDER CERTIFICATION FORM Practitioner Name: Practitioner Address: Practitioner Phone: Date: Shipment Information Recipient Name:
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CERTIFICATION FORM: Authorized Generic for EpiPen ...
www.epipen4schools.comCERTIFICATION FORM: Authorized Generic for EpiPen® (epinephrine injection, USP) Auto-Injector Authorized Generic for EpiPen4Schools® Replenishment Offer EPI-2017-0170 Mylan will replenish your school’s supply of Authorized Generic for EpiPen® or Authorized Generic for EpiPen Jr® (epinephrine injection, USP) Auto-Injectors prior to your annual eligibility date at no additional cost ...
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