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Archived - Diskus Recall Return Form
- Starting date:
- November 18, 2003
- Posting date:
- November 18, 2003
- Type of communication:
- Dear Healthcare Professional Letter
- Subcategory:
- Drugs, Medical Device
- Source of recall:
- Health Canada
- Audience:
- Healthcare Professionals
- Identification number:
- RA-17000495
Notice about Health Canada advisories
Ventolin® Diskus®/Flovent® Diskus®/Serevent® Diskus® Recall Return Form
Store Name/Store Number.:
Address:
GSK Direct Account No. or Wholesaler No.:
Wholesaler Account No.:
Recall Claim Number or Reference Number:
Pharmacist's Name:
Date:
Telephone:
Pharmacy Only
Wholesaler Only
No. of Diskus Units Returned By Patients
Professional Fee(s) @ $11 (for patient returns only)
No. of Diskus Units Returned from your inventory
Diskus Format:
No. of Diskus Units Returned from your inventory
Ventolin Diskus 200mcg
Serevent Diskus 50mcg
Flovent Diskus 50mcg
Flovent Diskus 100mcg
Flovent Diskus 250mcg
Flovent Diskus 500mcg
Total
Please Include This Form With Your Recalled Product Return by December 12, 2003
Please contact GSK Customer Service at 1-800-387-7374, if you have any questions regarding the recall.
Return to:
Central Distribution Centre
GlaxoSmithKline Inc.
11 Rimini Mews
Mississauga, Ontario L5N 4K1
Purolator Collect
Package pick up: 1-800-387-3027
Purolator Account #: 7354960
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