DEA 222 Form

To order DEA Form 222:

1)  Go to the Drug Enforcement Administration's Diversion website:     www.deadiversion.usdoj.gov

2)  Click on "online forms online" on the right banner.

3)  Fill in the order form with your applicable information.

4)  Order forms should arrive 2-4 weeks.

To fill out DEA Form 222:
Please note:  DEA Form 222 must not be altered in any way.  Alterations of any kind void Form 222.

Sample DEA Form 222.pdf

To send in orders from DEA Form 222
Please note:  We must have a valid 222 order form before any order may be shipped.

1)  Submit a copy of your current DEA Registration with Schedule II endorsement.

2)  Complete DEA Form 222

3)  Mail or FedEx DEA Form 222 with any necessary paperwork to:
               Cantrell Drug Company
               Attn:  Amy
               7524 Cantrell Road
               Little Rock, AR  72207

The follwing "Corresponding DEA 222 Form" may assist your office.  This form does not represent an order, but may be used for clarity between the prescribing physician and the pharmacist.
Corresponding DEA 222 Form.pdf