Request a Prescription Disposal Pouch

Please complete the form below to receive your FREE disposal pouch today.

* Indicates required field

Name *

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Last

Email *

Reason for Request *

Disposal location is too far. Lack of transportation.

Please select which size pouch you need. *

Mailing Address *

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State

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Deterra pouch requests are checked routinely. We mail out requests weekly, so your wait won't be too long. Thanks for helping us protect Mississippi.

Following receipt of your pouch by mail, you will receive a survey code. Please take the time to fill out the information so that we can continue to provide this service.

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Request a Drug Disposal Pouch.

Please complete the form below to receive your FREE disposal pouch today.