DisposeRx Packets
Please complete this form to receive DisposeRx packet(s). DisposeRx is an at-home site-of-use disposal solution for medications. To learn more, visit DisposeRx.com. Please allow 1-2 weeks for arrival of the packets. Packets will only be provided to those in South Dakota. Questions? Please contact the Resource Hotline at 1-800-920-4343.
Name
*
First Name
Last Name
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
Please Select
Minnehaha
Pennington
Lincoln
Brown
Brookings
Codington
Meade
Lawrence
Yankton
Davison
Beadle
Hughes
Union
Oglala Lakota
Clay
Lake
Roberts
Butte
Todd
Charles Mix
Custer
Turner
Hutchinson
Grant
Bon Homme
Fall River
Spink
Moody
Hamlin
Dewey
Mccook
Walworth
Day
Tripp
Brule
Kingsbury
Marshall
Deuel
Gregory
Corson
Edmunds
Lyman
Clark
Bennett
Hanson
Hand
Jackson
Stanley
Douglas
Perkins
Ziebach
Aurora
Sanborn
Mcpherson
Potter
Faulk
Miner
Haakon
Mellette
Buffalo
Jerauld
Campbell
Hyde
Sully
Harding
Jones
Out of State
If out of South Dakota use the option 'Out of State' (bottom option)
How many packets would you like to receive?
*
Please Select
1
2
3
4
5
You can receive up to 5 packets.
Admin
Submit
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