Templates for Formal Agreements with Pharmacies
Author: Public Health - Seattle & King County
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Lhj pharmacy mou template id4505
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This toolkit, developed by Public Health - Seattle & King County, provides a series of examples/templates for creating a formal partnership with pharmacies through Memorandum of Understanding and similar legal documents. The toolkit includes: -The Washington Statewide Pharmacy -Local Health Jurisdiction Memorandum of Understanding (MOU) template. A formal letter that would be provided by Public Health at the time of activation of the Statewide Pharmacy Agreement. The letter outlines the program and participant duties. An enrollment form through which participating pharmacies agree to certain duties. A Terms of Use template. An example of clinical guidance developed by Public Health. A Medication Withdrawal form that would be used to transfer custody of medications to the participating organization (pharmacy). A Medication Cache tracking form. A Medication Return Form.
Program: Public Health Preparedness
Submitted Date: Oct 13, 2016 | Modified Date: Sep 30, 2025
Primary Toolkit: Pharmacy Partnerships Toolkit | Secondary Toolkit: N/A
Jurisdiction: City
Institution Type: LHD - City, LHD - County,
Keywords: Public Health Preparedness, Influenza, Medical Countermeasures, Emergency Response
