• 1301 NW 84th Avenue, Suite 101A Miami, Florida 33126

    (800) 399-VETS (8387) Fax:(866) 421-5269

  • DEA REGISTRATION INFORMATION

  • REGISTERED STATE LICENSES / REGISTRATIONS

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  • BUSINESS INFORMATION

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  • Required Documentation

    1. Completed questionnaire.
    2. DEA and State Controlled Substance Registration.
    3. Any Letters of Admonition, Orders to Show Cause or Memorandum of Agreement with the DEA that are currently in effect or issued in the previous 5 years. Include any responses to these letters/documents.
    4. Disciplinary documents from local, state, or federal agencies.
    5. Copies of all DEA Form 106 submitted to the DEA in the prior 36 months
    6. Photographs of the interior and exterior of the facility and security features.
    7. Copies of any Power of Attorney documents in effect over the DEA Controlled Substance Registration.

    Thank you for completing the Amatheon Animal Health “Know Your Customer” Due Diligence Form. This allows Amatheon to obtain the necessary data to reasonably review your controlled substance purchases and to assist your hospital in protecting its own regulatory interests.

    The Code of Federal Regulations, 21CFR Part 1301.74(b) requires distributors of controlled substances to design and operate a system to identify suspicious orders. Suspicious orders may include those of unusual size, deviating substantially from a normal historical pattern, and/or orders of unusual frequency.

    (Reference https://www.deadiversion.usdoj.gov/21cfr/cfr/1301/1301_74.htm )

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