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Contract Concern

Select Form:

1. General Information

2. Incident Information

3. Contract Information

4. Supplier and Product Information

1. General Information

2. Incident Information

3. Contract Information

4. Product Information

1. General Information

2. Incident Information

3. Product Information

Member Success Form

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Tech Support Form

New Supplier Form

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Contracting Support Form

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Notice of Product Change

1. Person Submitting Form

2. Current Product Information

Please include pictures of current product and new product, clearly labeled. Include as many as necessary. Accepted file types: PNG, JPEG, PDF

3. Product Code Changes

Manufacturer Product Code
McKesson Product Code
CPDN Product Code
Other Distributor Code

4. Health Canada License Number Change

Drug Identification Number (DIN)
Natural Product Number (NPN)
Medical Device License (MDL)

5. GTIN and Barcode Change

GTIN on Unit of Purchase
GTIN on Unit of Use
GTIN on Case
Change in type of Barcode

6. Please indicate any changes to the format of your product

*For a product to be considered unit dose, it requires the following details for each individually wrapped tablet/capsule/liquid dose: generic name, strength, DIN, lot number, expiry date and name of manufacturer

7. Please describe any changes to the actual product appearance

Change in colour
Change in shape
Change to markings
Change to scoring on tablets
Change in dimensions
Change in weight of tablet/capsule/caplet/vial/ampoule

8. Package Size

Dimensions of outer package
Dimensions of inner package
Number of units per package
Change to case: weight
Change to case dimensions: Length/Width/Height

9. Other Changes

Change in concentration
Change in preservative content
Change in excipients or non-medicinal ingredients
Change in reconstitution instructions
Change in storage conditions
Change in stability information
Change in natural rubber latex content
Change to drug container (e.g. vial, ampoule)
Change in security features
Change to branding or other graphics
Other label changes
Other: please specify

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L6H 6K8

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