September 27, 2018

Dear Pharmacy Partners,

Eastern Idaho Public Health is asking for your assistance in collecting local pharmaceutical data.  This is part of the Centers for Disease Control and Prevention (CDC) requirement regarding the Strategic National Stockpile (SNS).  During a public health emergency, local caches of medication would be used prior to receiving requested SNS medication being shipped to Idaho by the CDC.

We are asking your assistance in collecting data regarding average milligrams on-hand of Doxycycline, Ciprofloxacin, Oseltamivir (Tamiflu©), and Zanamivir (Relenza©), which could be prescribed in the event of a public health emergency.  The information collected will only be shared with the CDC through our State partners in our contract reporting process.

Please indicate below your pharmacy’s average milligrams on-hand of Doxycycline, Ciprofloxacin, Oseltamivir (Tamiflu©), and Zanamivir (Relenza©) that is available for prescription.  Fax this completed form to Eastern Idaho Public Health at 208-533-3143.  If possible, please complete and fax this form no later than 4:00 pm on September 27, 2018.

I appreciate and thank you for your time and support in this matter and for partnering with us to ensure our local citizens and communities needs are met in the event of a public health emergency.  If you have questions regarding the Public Health Preparedness Program or this medication supply inventory, please contact Troy Nelson by phone at
(208) 533-3146, or by email at tnelson@eiph.idaho.gov.

Sincerely,

Geri L. Rackow, Director

Pharmacy Contact Information

Pharmacy Name and Address:_____________________
 
Contact Name:  _________________________________

Phone Number: _________________________________

*Pharmaceutical Data*

Medication Number of Milligrams Available
Ciprofloxacin:_____________________
Doxycycline :_____________________
Oseltamivir :______________________

Medication Number of Kits Available
Zanamivir :__________________