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CURES Direct Dispense Application

Pharmacy/Dispenser Registration for Access

This Direct Dispense Application is for reporting DISPENSED prescriptions ONLY.

Please DO NOT register if you are only WRITING prescriptions or ADMINISTERING in the office.

This application is NOT for Patient Activity Reports (PAR), go to

http://oag.ca.gov/cures-pdmp.

Due to the high volume of registrants, we will not be able to process in the 24-48 hour period as specified.

Thank you for your patience.



Dispenser


California License Number*

 

DEA Number*

First Name*

Last Name*

Business Name

Address*

business home

City*

State*

Zip Code*

Telephone*

Fax

Email*

Contact First Name

Contact Last Name

Pharmacy Software Vendor

* required

Upon submitting, this information will no longer be available to you. Please use your browser’s print button to keep a copy for your records.