Request a Narcan Direct Ordering Account

Current Certified Provider Information
Complete

To request a Narcan Direct ordering account, complete and submit this form. Accounts are created in the order requests are received, and you will receive an email once your account is ready.

If you already have an account, you can place your order by visiting Narcan Direct

If you have any questions, email [email protected].

Certification

Office of Addiction Services and Supports (OASAS)

Office of Mental Health (OMH)

Office of Children and Family Services (OCFS)

First Responders

Certified Provider Name

Provider Identification Number

First/Last Name

Address

City/Town

State/Province

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Phone Number