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Putnam County Narcan & Deterra Request
**** Please submit request at least
1 MONTH
prior to the date needed.
1.
Please provide your information below:
Organization Name
County
First Name
Last Name
Position
Email
Tel.
2.
County where the Narcan/Deterra will be distributed:
3.
Number of Narcan units needed?
NOTE- 1 unit contains 2 single nasal spray devices. 12 units come in a box. Please put request in as UNITS.
4.
Number of Deterra bags needed?
5.
Please provide a brief description of why Narcan/Deterra request is being submitted.
6.
Date of event/strategy the Narcan/Deterra is needed:
