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Supply Requirements Form

Supply Requirements Form

AstraZeneca Supply of Medicines.

Please find below AstraZeneca's Emergency Supply Requirements form.

AstraZeneca’s prime concern is to ensure patient welfare by making sure that patients have access to the products that they need. In order to minimize the risk of product shortages in the UK, AstraZeneca takes the appropriate measures to ensure that it has visibility of the levels of stock in circulation and can maintain continuity of supply to the whole of the UK.

AstraZeneca is keen to ensure that appropriate information & support is given to customers and to address any factors which may lead to a pharmacy having difficulty accessing an Astrazeneca product.

If you are experiencing problems obtaining AstraZeneca stock, you can request a review of your allocation by completing the form attached and returning it by email or fax to the Supply Chain team. Your account will then be reviewed but you should note that we can give no guarantee that this will lead to a variation to your allocation.

Please note - THIS IS NOT AN ORDER FORM

  1. Complete the online ‘Supply Requirements Form’
  2. Download the pdf version of the ‘Supply Requirements Form’, populate by hand and fax to us or scan and email to us as per instructions on the form
  3. Download the Microsoft Excel version of the ‘Supply Requirements Form’ – populate by hand or electronically and fax or email to us as per instructions on the form
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Please note:

Information provided in this form may be subject to verification using third party data sources and such information will be used in accordance with your AstraZeneca Supply Contract. Data submitted to us will be subject to our 'privacy policy'.

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Supply Requirements Form

If you are experiencing any problems obtaining AstraZeneca medicines please click here for our Supply Requirements form.

Faulty Products

All faulty products should also be reported to AstraZeneca on 0800 783 0033. Alternatively, please visit our FAQ section.

Adverse events

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