Naloxone Dispensing Program

Free Narcan (Naloxone) Request

As part of the state's comprehensive plan to combat drug abuse, Stine's Apothecary is now stocking Narcan®, an FDA-approved nasal form of naloxone. The medication, administered by nasal spray, can be used in the event of an overdose to reverse the effects of opioid drugs, which include some prescription painkillers and heroin. As part of the new state program, Narcan will be available free of charge to any patient or caregiver who requests it. If your interested in receiving Narcan free of charge please fill out the form below. Also under this program, you can choose to remain anonymous if you choose to.
Do you want to remain anonymous?

NoYes
Method of Request

Online
Person Requesting
Do you want to pickup in store or shipped to your house?

Pickup In StoreShip to me
Ship to Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number
Please enter a valid phone number.
I have requested the pharmacy to provide Naloxone under the Naloxone Pilot Program in NJ, that allows pharmacies that have obtained standing orders from the Commissioner of Health or a New Jersey licensed physician to dispense opioid antidotes, at no cost, to recipients anonymously.
All orders will be ready for pickup same day will be shipped in 1-2 business days. Please have your registered phone number ready when coming to pickup.
Signature of patient (or legal representative)

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Free Narcan (Naloxone) Request