Tasmanian Palliative Care Prepared Pharmacy Program

Register for ComPPaCT

By submitting this form you agree to keep a regular supply of medicines as listed on the Tasmanian Palliative Care Core Medicines List from each of the five medicine categories.

Pharmacy

Name of Pharmacy *

Address *

Address 2

Address 3

City *

State * ACTNSWNTQLDSATASVICWA

Postcode *

Country *

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Contact

Pharmacy Owner *

Pharmacist in Charge *

Pharmacy Email *

Pharmacy Phone Number *

Name of person agreeing to participate in the program on behalf of the pharmacy *

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