Application Form for Narcan Emergency Boxes

Instructions: Please complete and submit the form below.  We will contact you when your Narcan Emergency Box is ready to be picked up.  

Permission: By submitting this form, I confirm that I am an authorized representative of the establishment listed below, and that the site personnel agree to keep a limited supply of Narcan/naloxone on the premises, collect necessary distribution paperwork, and to refer interested individuals to comprehensive community Narcan trainings as schedule permits.  I also understand that my site may be listed on the public access listing on the Erie County Opiate Epidemic Task Force website.  I agree to visually inspect the Narcan Emergency Box at least once per week and resupply with Narcan as needed.

Frequently Requested

Contact

Phone: (716) 858-7690

Fax: (716) 858-8701

Erie County Department of Health (ECDOH)
95 Franklin Street
Buffalo, New York 14202

ECDOH Locations

Western New York 211