Report Pharmacy Access Issues Question Title * 1. What is the name of the pharmacy? Question Title * 2. What's the address of the pharmacy? Question Title * 3. Are you a member of ASAM? Yes No I don't know. Question Title * 4. What medication did you prescribe? Buprenorphine/naloxone film Buprenorphine/naloxone tablet Buprenorphine mono-product (oral) Naltrexone (oral) Disulfiram Acomprosate Varenicline Multiple, including buprenorphine mono-product Multiple, not including buprenorphine mono-product Extended-release buprenorphine Extended-release naltrexone Other (please specify) Next
