Long-Term Pharmacy Services | Heartland Pharmacy

Equipment Request Form

Once this ticket has been submitted, a Heartland Pharmacy representative will contact you for solutions, costs and additional information regarding your equipment.

Name(Required)

Phone(Required)

Email(Required)

Community Name(Required)

Community Address(Required)

Scanner Issues:

Med Cart Serial Number:

Lock Issues:

Keys:

Narc Box/Drawer

Sharps

Main Cart

Rails:

Additional Equipment Requests:

More Information:

For laptop and fax machine questions, trouble shooting, etc. please call Treasure Valley IT at 208-367-1000 or help@tvit.net.

*Please be aware that service fees and charges may apply to this ticket and request.

Equipment Request Form

Corporate Office

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Fill out the form below to get a quick, reliable answer.

Fill out the form below to get a quick, reliable answer.