University of Texas - College of Pharmacy

ISPOR Drug Cards

Order Form

Please submit the following information to request an ISPOR Drug Card. Your information will not be shared with any other parties, and will only be used for this purpose. If you selected your Drug Cards set to be mailed to you, please, include $3.55 USPS media mail postage to your check payable to UT-ISPOR. Please, mail your check to :

Pooja Desai, Division of Pharmacy Administration
College of Pharmacy
1 University Station A1930
Austin, TX, 78712.

Requests outside the US will be handled individually.

First Name:

Last Name:

Address 1:

Address 2:

City:

State:

Zip:

Country:

Phone:

E-mail Address:

Drug cards type	Quantity
Rx OTC Inject Diet	Num. of RX Num. of OTC Num. of Inject Num. of Diet
Delivery Method (please select one box only)
Please mail me my drug cards I will pick my drug cards up at PHR 2.210

Comments (Enter text below):

(Download PDF Reader.)

Last Reviewed: August 12, 2010

College Information

Mailing Address:
College of Pharmacy
The University of Texas
at Austin
2409 University Ave.
Stop A1900
Austin, TX, USA
78712-1113

Email Address: pharmacy
@www.utexas.edu

Phone:
1-512-471-1737