Medical Crash Cart Medications Auto-Replenishment Request for Quote

Please follow instructions below. HealthFirst will use the information to prepare a custom crash cart automatic medication replenishment program based on your specific needs.

You will need to have a list ready that includes medications, by name and strength, or simply enter the NDC, and the quantities needed for each item.

To complete the Medications Auto-Replenishment Request for Quote, please continue on a desktop computer.

Practice Name*
Contact Name*
Medical Specialty*
Customer # (if applicable)
Email Address*
Phone Number*
Phone Ext.
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How did you hear about us?
Name
StrengthSize
Pharma, 2 Gallon Pharmaceutical Recovery (1 included in program)
ACTIDOSE-AQUA 25grams ACTIVATED CHARCOAL TUBE
25grams120mL
ADENOSINE INJECTION, USP 60mg/20mL (3mg/mL) 20mL VIAL
3mg/mL20mL
ADENOSINE INJECTION, USP 6mg/2mL (3mg/mL) VIAL
6mg/2mL (3mg/mL)2mL
ADRENALIN(R) INJECTION (EPINEPHRINE INJECTION, USP) 1mg/mL 30mL VIAL
1mg/mL30mL
ADRENALIN® (EPINEPHRINE INJECTION, USP) 1mg/mL 1:1000 VIAL
1mg/mL 1:10001mL
AMINOPHYLLINE INJ., USP 500mg (25mg/mL)
25mg/mL20mL
AMINOPHYLLINE INJECTION, USP 250mg (25mg/mL) 10mL VIAL
250mg (25mg/mL)10mL
AMIODARONE HYDROCHLORIDE INJECTION 150mg/3mL (50mg/mL) VIAL
150mg/3mL (50mg/mL)3mL
AMMONIA INHALANT 0.3mL
0.3mL
ASPIRIN 325mg 100 PER BOTTLE
325mg100 TAB
ASPIRIN TABLETS (CHEWABLE) LOW DOSE, 81mg 90 PER BOTTLE
81mg90 TAB
ATROPINE SULFATE INJECTION, USP 0.4mg/mL 1mL VIAL
0.4mg/mL1mL
ATROPINE SULFATE INJECTION, USP 0.5mg (0.1 mg/mL) SYR
0.5mg (0.1 mg/mL)5mL
ATROPINE SULFATE INJECTION, USP 1mg (0.1mg/mL) SYR
1mg (0.1mg/mL)10mL
ATROPINE SULFATE INJECTION, USP 8mg/20mL (0.4mg/mL) 20mL VIAL
8mg/20mL (0.4mg/mL)20mL
AUVI-Q(R) EPINEPHRINE INJECTION, USP 0.15mg AUTO INJECTOR
.15mg0.76mL
AUVI-Q(R) EPINEPHRINE INJECTION, USP 0.3mg AUTO INJECTOR
.3mg0.76mL
BACTERIOSTATIC 0.9% SODIUM CHLORIDE INJECTION, USP 10mL VIAL
0.9% 10mL10mL
BACTERIOSTATIC 0.9% SODIUM CHLORIDE INJECTION, USP 30mL VIAL
0.9% 30mL30mL
CALCIUM CHLORIDE INJECTION 10%, USP 1gram (100mg/mL) SYR
1gram (100mg/mL)10mL
CALCIUM GLUCONATE INJECTION, USP 10% (100mg/mL) 50mL VIAL
100mg/mL50mL
CALCIUM GLUCONATE INJECTION, USP 10% 1,000 mg per 10mL (100mg/mL) 10mL VIAL
100mg/mL10mL
CHILDREN'S IBUPROFEN ORAL SUSPENSION 100mg PER 5mL
100mg5mL
CLONIDINE HCI INJECTION 1000mcg/10mL (100mcg/mL) 10mL VIAL
100mcg/mL10mL
CLONIDINE HYDROCHLORIDE 0.1mg. USP, ONE TABLET
0.1mg1 tablet
CLORAPREP® SINGLE SWABSTICK 1.75mL
1.75mLSwabstick
DEXAMETHASONE SODIUM PHOSPHATE INJECTION, USP 10mg/mL 2mL VIAL
10mg/mL2mL
DEXAMETHASONE SODIUM PHOSPHATE INJECTION, USP 20mg/5mL (4mg/mL) VIAL
20mg/5mL (4mg/mL)5mL
DEXTROSE INJECTION 5%, USP 100mL BAG
5% DEXTROSE PER 100mL100mL
DEXTROSE INJECTION 5%, USP 250mL BAG
5%250mL
DEXTROSE INJECTION 5%, USP 500mL BAG
5%500mL
DEXTROSE INJECTION 50%, USP 25grams (0.5g/mL) 50mL SYR
25grams (0.5g/mL)50mL
DEXTROSE INJECTION 50%, USP 25grams/50mL (0.5g/mL) VIAL
25grams/50mL (0.5g/mL)50mL
DIGOXIN INJECTION, USP 500mcg/2mL 0.5/2mL (250mcg/mL) AMP
500mcg/2mL 0.5/2mL (250mcg/mL)2mL
DILTIAZEM HYDROCHLORIDE INJECTION 25mg/5mL (5 mg/mL) 5mL VIAL
25mg/5mL (5 mg/mL5mL
DIPHENHYDRAMINE HCI 25mg ONE CAPSULE
25mg1 capsule
DIPHENHYDRAMINE HCI INJECTION, USP 50mg/mL 1mL CARP
50mg/mL1mL
DIPHENHYDRAMINE HCI INJECTION, USP 50mg/mL 1mL VIAL
50mg/mL1mL
DOBUTAMINE IN 5% DEXTROSE INJECTION, USP 500mg 250mL BAG
500mg250mL
DOBUTAMINE INJECTION, USP 250mg PER 20mL VIAL
250mg PER 20mL20mL
DOPAMINE HCI INJ., USP 200mg (40 mg/mL) 5mL VIAL
200mg (40 mg/mL)5mL
DOPAMINE HCI INJ., USP 400mg (40mg/mL) 10mL VIAL
400mg (40mg/mL)10mL
DOPAMINE HYDROCHLORIDE IN 5% DEXTROSE INJECTION, USP 400mg 250mL BAG
400mg250mL
EPHEDRINE SULFATE INJECTIONS, USP 50 mg/mL 1mL VIAL
50 mg/mL1mL
EPINEPHRINE INJECTION, USP 1mg/10mL (0.1mg/mL) SYR (1:10,000)
1mg/10mL (0.1mg/mL)10mL
EPINEPHRINE INJECTION, USP AUTO INJECTOR 0.15mg
0.15mg2mL
EPINEPHRINE INJECTION, USP AUTO INJECTOR 0.30mg
0.30mg2mL
FLUMAZENIL INJECTION, USP 0.5mg/5mL (0.1mg/mL) VIAL
0.5mg/5mL (0.1mg/mL)5mL
FLUMAZENIL INJECTION, USP 1mg/10mL (0.1 mg/mL) VIAL
1mg/10mL (0.1 mg/mL)10mL
FUROSEMIDE INJ., USP 20mg/2mL (10mg/mL) VIAL
20mg/2mL (10mg/mL)2mL
FUROSEMIDE INJECTION, USP 100mg (10mg/mL) 10mL VIAL
100mg (10mg/mL)10mL
FUROSEMIDE INJECTION, USP 40mg/4mL (10 mg/mL) 4mL VIAL
10mg/mL4mL
GLUCAGEN(R) {GLUCAGON (rDNA ORGIN) FOR INJECTION} 1mg PER KIT
1mg1mL
HETASTARCH 6% IN 0.9% SODIUM CHLORIDE INJECTION 500mL BAG
6% and 0.9%500mL
INFANT 25% DEXTROSE INJECTION, USP 2.5g (250mg/mL) ANSYR SYR
2.5g (250mg/mL)10mL
INFANT 4.2% SODIUM BICARBONATE INJ, USP 5mEq (0.5 mEq/mL) 10mL SYR
0.5 mEq/mL10mL
INSTA-GLUCOSE®
31g1.09oz
INTRALIPID 20% 250mL BAG
20%250mL
KETOROLAC TROMETHAM 60mg/2mL VIAL
60mg/2mL2mL
KETOROLAC TROMETHAMIN 30mg/mL 1mL VIAL
30mg/mL1mL
LABETALOL HYDROCHLORIDE INJECTION, USP 100mg/20mL (5mg/mL) VIAL
100mg/20mL (5mg/mL)20mL
LACTATED RINGER'S AND 5% DEXTROSE INJECTION, USP 1000mL BAG
600mg/100mL1000mL
LACTATED RINGER'S INJECTION, USP 1000mL BAG
1000mL
LACTATED RINGER'S INJECTION, USP 500mL BAG
500mL
LEVOPHED(R) NOREPINEPHRINE BITARTRATE INJECTION, USP 4mg/4mL 4mL VIAL
4mg/4mL4mL
LIDOCAINE HCI 1% AND EPINEPHRINE 1:100,000 INJECTION, USP 20mL VIAL
1% and 1:100,00020mL
LIDOCAINE HCI AND 5% DEXTROSE INJECTION USP 2g (4mg/mL) 500mL BAG
2g (4mg/mL)500mL
LIDOCAINE HCI INJ. 2%, USP 100mg/5mL SYR
100mg/5mL5mL
LIDOCAINE HCI INJECTION 2%, USP 1000mg/50mL (20mg/mL) 50mL VIAL
1000mg/50mL (20mg/mL)50mL
LIDOCAINE HCI INJECTION 2%, USP 100mg/5mL (20mg/mL) VIAL
100mg/5mL (20mg/mL)5mL
LIDOCAINE HCI INJECTION, USP 1% 50mg/5mL SYR
50mg/5mL5mL
MAGNESIUM SULFATE INJECTION 50%, USP 5grams/10mL ANSYR SYR
5grams/10mL10mL
MAGNESIUM SULFATE INJECTION, USP 50% 10g/20mL (0.5g/mL) 20mL VIAL
0.5g/mL20mL
METOCLOPRAMIDE INJ., USP 10mg/2mL (5mg/mL) VIAL
10mg/2mL (5mg/mL)2mL
METOPROLOL TARTRATE INJECTION, USP 5mg/5mL (1mg per mL) AMP
5mg/5mL (1mg per mL)5mL
MIDAZOLAM INJECTION, USP 2mg/mL (1mg/mL) 2mL iSECURE
2mg/mL (1mg/mL)2mL
MIDAZOLAM INJECTION, USP 5mg/5mL (1mg/mL) PF 5mL VIAL
5mg/5mL (1mg/mL)5mL
MIDAZOLAM INJECTION, USP 5mg/mL 1mL VIAL
5mg/mL1mL
NALOXONE HCI INJECTION, USP 0.4mg/mL 1mL VIAL
0.4mg/mL1mL
NALOXONE HYDROCHLORIDE INJ., USP (1mg/mL) 2mL SYR
1mg/mL2mL
NALOXONE HYDROCHLORIDE INJECTION, USP 0.4mg/mL 1mL CARP
0.4mg/mL1mL
NARCAN NALOXONE HCI NASAL SPRAY 4mg/.1mL 2-PACK
4mg/.1mL0.1mL 2pack
NITROGLYCERIN IN 5% DEXTROSE INJECTION 50mg PER 250mL VIAL
50mg PER 250mL250mL
NITROGLYCERIN LINGUAL SPRAY 400mcg PER SPRAY 60 METERED SPRAYS
400mcg per spray4.9g
NITROGLYCERIN SUBLINGUAL TABLETS, USP 0.4mg/TABLET 25TABS
0.4mg/tablets25 tablets
NTG PASTE 2% TUBE
2%30gm TUBE
ONDANSETRON INJECTION, USP 4mg/2mL (2mg/mL) VIAL
4mg/2mL (2mg/mL)2mL
ONDANSETRON ORALLY DISINTEGRATING TABLET USP 4mg
4mg1 tablet
PHENYLEPHRINE HCI INJECTION, USP 10mg/mL 1mL VIAL
10mg/mL1mL
PHENYTOIN SODIUM INJ., USP 100mg/2mL (50mg/mL) VIAL
100mg/2mL (50mg/mL)2mL
PHENYTOIN SODIUM INJ., USP 250mg/5mL (50mg/mL) VIAL
250mg/5mL (50mg/mL)5mL
PROAIR® HFA (ALBUTEROL SULFATE) 90mcg
90mcg8.5gr
PROCAINAMIDE HCI INJECTION, USP 1gram/10mL TOTAL (100mg/mL) 10mL VIAL
1gram/10mL TOTAL (100mg/mL)10mL
PROMETHAZINE HCI INJECTION, USP 25mg/mL 1mL VIAL
25mg/mL1mL
PROMETHAZINE HCI INJECTION, USP 50mg/mL 1mL AMPULE
50mg/mL1mL
PROPOFOL INJECTION EMULSION 200mg/20mL (10mg/mL) VIAL
200mg/20mL (10mg/mL)20mL
PROPRANOLOL HYDROCHLORIDE INJECTION, USP 1mg/mL 1mL VIAL
1mg/mL1mL
SODIUM BICARBONATE 4% (2.4%mEq) ADDITIVE SOLUTION 5mL
4%5mL
SODIUM BICARBONATE INJ. 8.4%, USP 50mEq (1mEq/mL) 50mL VIAL
50mEq (1mEq/mL)50mL
SODIUM BICARBONATE INJECTION 8.4%, USP 50mEq (1mEq/mL) 50mL SYR
50mEq (1mEq/mL)50mL
SODIUM CHLORIDE INJECTION 0.9% USP ZR(TM) 10mL SYR
0.90%10mL
SODIUM CHLORIDE INJECTION 0.9%, USP 1000mL BAG
0.9% PER 1000mL1000mL
SODIUM CHLORIDE INJECTION 0.9%, USP 100mL BAG
0.9% PER 100mL100mL
SODIUM CHLORIDE INJECTION 0.9%, USP 10mL VIAL
0.90%10mL
SODIUM CHLORIDE INJECTION 0.9%, USP 250mL BAG
0.9% 250mL250mL
SODIUM CHLORIDE INJECTION 0.9%, USP 500mL BAG
0.9% 500mL500mL
SOLU-CORTEF® 100mg 2mL ACT-O-VIAL®
100mg2mL
SOLU-CORTEF® 250mg 2mL ACT-O-VIAL®
250mg2mL
SOLU-MEDROL® 125MG PER VIAL 2mL ACT-O-VIAL®
125mg2mL
SOLU-MEDROL® 40MG PER VIAL 1mL ACT-O-VIAL®
40mg1mL
STERILE WATER FOR INJECTION, USP 100mL VIAL
100mL
STERILE WATER FOR INJECTION, USP 10mL VIAL
10mL
STERILE WATER FOR INJECTION, USP 50mL VIAL
50mL
VASOSTRICT(TM) (VASOPRESSIN INJECTION, USP) 20 UNITS PER mL 1mL VIAL
20 UNITS PER mL1mL
VENTOLIN® HFA (ALBUTEROL SULFATE) 90mcg
90mcg8gm
VERAPAMIL HCI INJECTION, USP 5mg/2mL (2.5 mg/mL) VIAL
5mg/2mL (2.5 mg/mL)2mL
VERAPAMIL HYDROCHLORIDE INJECTION, USP 10mg (2.5 mg/mL) 4mL ANSYR SYR
10mg (2.5 mg/mL)4mL
Additional Medications Needed
Medication Name
Strength
Size
Manufacturer NDC#
Qty.
Row 2 Name
Row 2 Strength
Row 2 Size
Row 2 NDC#
Row 2 Qty.
Row 3 Name
Row 3 Strength
Row 3 Size
Row 3 NDC#
Row 3 Qty.
Row 4 Name
Row 4 Strength
Row 4 Size
Row 4 NDC#
Row 4 Qty.

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Medical Crash Cart Medications Auto-Replenishment Request for Quote

Additional Medications Needed

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