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Form 224 Instructions
DEA Form 224
New Application for Registration Instructions
SECTION
1. APPLICANT IDENTIFICATION
Information must be
typed or printed in the blocks provided to help reduce data entry errors.
A physical address is required; after the street address a post
office box may be included.
Fee exempt applications must list the name and address of the fee exempt
institution.
Applicant must enter a valid social security
number (SSN), or a tax identification number (TIN) if applying as a business
entity.
Debt collection
information is mandatory pursuant to the Debt Collection Improvement Act of
1996
The email address,
point of contact, national provider id, date of birth, year graduated, and
professional school are new data items that are in the process of OMB
approval and will soon be mandatory. They are requested in order to
facilitate communication or as required by inter-agency data sharing
requirements.
Practitioners also enter one degree from this list: DDS, DMD, DO, DPM, DVM,
MD or PHD.
Midlevel practitioners also enter one degree from these choices:
DOM, HMD, MP, ND, NP, OD, PA, or RPH.
SECTION
2. BUSINESS ACTIVITY
Indicate only one.
Practitioner or mid-level practitioner must enter the degree conferred, and
are requested to enter the last professional school of matriculation and the
year graduated.
ADS must provide
current DEA registration number of parent retail pharmacy or hospital, and
attach a notarized
affidavit (21 CFR Part 1301.17). Affidavit must include
-
Name of parent
retail pharmacy and complete address
-
Name of
Long-term Care (LTC) facility and complete address
-
Permit or
license number(s) and date issued of State certification to operate ADS
at named LTC facility
-
Required
Statement:
This affidavit is submitted to obtain a DEA registration number. If any
material information is false, the Administrator may commence
proceedings to deny the application under section 304 of the Act (21
U.S.C. 8224(a)). Any false or fraudulent material information contained
in this affidavit may subject the person signing this affidavit, and the
named corporation/partnership/business to prosecution under section 403
of the Act (21 U.S.C 843).
-
Name of
corporation operating the retail pharmacy
-
Name and title
of corporate officer signing affidavit
-
Signature of
authorized officer
SECTION
3. DRUG SCHEDULES
Applicants should
check all drug schedules to be handled. However, applicants must still
comply with state requirements; federal registration does not overrule state
restrictions. Check the order form box only if you intend to purchase or to
transfer schedule II controlled substances. Order forms will be mailed to
the registered address following issuance of a Certificate of Registration.
The following list of drug codes are examples of controlled substances for
schedules 2, 3, 4, and 5. Refer to the CFR for a complete list of basic
classes.
DRUG SCHEDULES
Listed below are examples of the
schedules with assigned drug code numbers. If you are in need of additional
information, see 21 CFR 1308 or contact the DEA office serving your
area.
Schedule II
NARCOTIC BASIC
CLASSES |
CODE |
Alphaprodine (Nisentil) |
9010 |
Anileridine (Leritine) |
9020 |
Cocaine (Methyl
Benzoylecgonine) |
9041 |
Codeine (Morphine methyl
ester) |
9050 |
Dextropropoxyphene (bulk) |
9273 |
Diphenoxylate |
9170 |
Diprenorphine (M50-50) |
9058 |
Ethylmorphine (Dionin) |
9190 |
Etorphine Hydrochloride
(M-99) |
9059 |
Glutethimide (Doriden,
Dorimide) |
2550 |
Hydrocodone (Dihydrocodeinone) |
9193 |
Hydromorphone (Dialudid) |
9150 |
Levo-alphacetylmethadol (LAAM) |
9648 |
Levorphanol (Levo-Dromoran) |
9220 |
Meperidine (Demerol, Mepergan) |
9230 |
Methadone (Dolophine,
Methadose) |
9250 |
Morphine (MS Contin, Roxanol) |
9300 |
Opium, powdered |
9639 |
Opium, raw |
9600 |
Oxycodone (Oxycontin,
Percocet) |
9143 |
Oxymorphone (Numorphan) |
9652 |
Opium Poppy / Poppy Straw |
9671 |
Poppy Straw Concentrate |
9670 |
Thebaine |
9333 |
|
|
NON-NARCOTIC BASIC
CLASSES |
CODE |
Amobarbital (Amytal, Tuinal) |
2125 |
Amphetamine (Dexedrine,
Adderall) |
1100 |
Methamphetamine (Desoxyn) |
1105 |
Methylphenidate (Concerta,
Ritalin) |
1724 |
Pentobarbital (Nemutal) |
2270 |
Phencyclidine (PCP) |
7471 |
Phenmetrazine (Preludin) |
1631 |
Phenylacetone |
8501 |
Secobarbital (Seconal) |
2315 |
Schedule III
NARCOTIC BASIC
CLASSES |
CODE |
Buprenorphine (Buprenex,
Temgesic, Subutex |
9064 |
Codeine combo product up to 90
mg/du (Empirin) |
9319 |
Dihydrocodeine combo prod 90
mg/du (Compal) |
9807 |
Ethylmorphine combo product 15
mg/du |
9808 |
Hydrocodone combo product (Lorcet,
Vicodin) |
9806 |
Morphine combo product 50 mg/100ml or
gm |
9810 |
Opium combo product 25 mg/du
(Paregoric) |
9809 |
|
|
NON-NARCOTIC BASIC
CLASSES |
CODE |
Anabolic Steroids |
4000 |
Benzphetamine (Didrex,
Inapetyl) |
1228 |
Butalbital (Fiorinal,
Butalbital w/aspirin) |
2100/2165 |
Dronabinol in sesame oil
w/soft gelatin capsule |
7369 |
GHB Drug Product (gamma-Hydroxybutyric
acid) |
2010 |
Ketamine (Ketaset) |
7285 |
Methyprylon (Noludar) |
2575 |
Pentobarbital suppository du
& noncontrolled active ingred. (FP-3, WANS) |
2271 |
Phendimetrazine (Plegine,
Bontril, Statobex |
1615 |
Secobarbital suppository du
& noncontrolled active ingredients |
2316 |
Thiopental (Pentothal) |
2100/2329 |
Vinbarbital (Delvinal |
2100/2335 |
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Schedule IV
BASIC
CLASSES |
CODE |
Alprzolam (Xanax) |
2882 |
Barbital (Veronal, Plexonal,
Barbitone) |
2145 |
Chloral Hydrate (Noctec) |
2465 |
Chlordiazepoxide (Librium,
Libritabs) |
2744 |
Clorazepate (Tranxene) |
2768 |
Dextropropoxyphene du (Darvon) |
9278 |
Diazepam (Valium, Diastat) |
2765 |
Diethylpropion (Tenuate,
Tepanil) |
1610 |
Difenoxin 1mg/25ug atropine
SO4/du (Motofen) |
9167 |
Fenfluramine (Pondimin,
Dexfenfluramine) |
1670 |
Flurazepam (Dalmane) |
2767 |
Halazepam (Paxipam) |
2762 |
Lorazepam (Ativan) |
2885 |
Mazindol (Sanorex, Mazanor) |
1605 |
Mebutamate (Capla) |
2800 |
Meprobamate (Miltown,
Equanil) |
2820 |
Methohexital (Brevital |
2264 |
Methylphenobarbital (Mebaral) |
2250 |
Midazolam (Versed) |
2884 |
Oxazepam (Serax, Serenid-D)) |
2835 |
Paraldehyde (Paral) |
2585 |
Pemoline (Cylert) |
1530 |
Pentazocine (Talwin,
Talacen) |
9709 |
Phenobarbital (Luminal,
Donnatal) |
2285 |
Phentermine (Ionamin,
Fastin, Zantryl) |
1640 |
Prazepam (Centrax) |
2764 |
Quazepam (Doral) |
2881 |
Temazepam (Restoril) |
2925 |
Triazolam (Halcion) |
2887 |
Zolpidem (Ambien, Ivadal,
Stilnox) |
2783 |
Schedule V
BASIC
CLASSES |
CODE |
Codeine Cough Preparation (Cosanyl,
Pediacof) |
9100 |
Difenoxin Preparation (Motofen) |
9167 |
Dihydrocodeine Preparation (Cophene-S) |
9120 |
Diphenoxylate Preparation (Lomotil, Logen) |
9170 |
Ethylmorphine Preparation |
9190 |
Opium Preparation (Kapectolin PG) |
9809 |
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SECTION
4. STATE LICENSE(S)
Federal
registration by DEA is based upon the applicant 's compliance with
applicable state and local laws. Applicants should contact the local state
licensing authority prior to completing this application. If your state
requires a separate controlled substance number, provide that number on this
application.
SECTION
5. LIABILITY
Applicants must
answer all four questions for the application to be accepted for processing.
If you answered "Yes" to any question, provide an explanation in
the space provided. If you answer "Yes" to several of the
questions, then you must provide a separate explanation describing the
location, nature, and result of incident for each "Yes" answer. If additional space is required, you may attach a
separate sheet of paper.
SECTION
6. EXEMPTION APPLICATION FEE
Exemption from
payment of application fee is limited to federal, state or local government
official or institution. The applicant's superior or
agency officer must certify exempt status. The signature, authority title,
and telephone number of the certifying official (other than the applicant)
must be provided. The address of the fee exempt institution must appear in
Section 1.
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SECTION
7. METHOD OF PAYMENT
Indicate the
desired method of payment. Make checks payable to "Drug Enforcement
Administration". Third-party checks or checks drawn on foreign banks
will not be accepted. FEES ARE NON-REFUNDABLE.
SECTION
8. APPLICANT'S SIGNATURE
Applicant MUST
sign in this section or application will be returned. Card holder signature
in section 7 does not fulfill this requirement.
CONTACT
INFORMATION
1. INTERNET
www.deadiversion.usdoj.gov
2. TELEPHONE Headquarters Call Center (800) 882-9539
3. WRITTEN INQUIRIES –
Drug
Enforcement Administration
Registration Section/ODR
P.O. Box 2639
Springfield, VA 22152-2639
4. DEA OFFICES (800,
877, and 888 are toll-free numbers)
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Notice
to Registrants Making Payment by Check
Authorization to
Convert Your Check:
If you send us a
check to make your payment, your check will be converted into an electronic
fund transfer. "Electronic fund transfer" is the term used to
refer to the process in which we electronically instruct your financial
institution to transfer funds from your account to our account, rather than
processing your check. By sending your completed, signed check to us, you
authorize us to copy your check and to use the account information from your
check to make an electronic fund transfer from your account for the same
amount as the check. If the electronic fund transfer cannot be processed for
technical reasons, you authorize us to process the copy of your check.
Insufficient
Funds:
The electronic
funds transfer from your account will usually occur with 24 hours, which is
faster than a check is normally processed. Therefore, make sure there are
sufficient funds available in your checking account when you send us your
check. If the electronic funds transfer cannot be completed because of
insufficient funds, we may try to make the transfer up to two times.
Transaction
Information:
The electronic fund
transfer from your account will be on the account statement you receive from
your financial institution. However, the transfer may be in a different
place on your statement than the place where your checks normally appear.
For example, it may appear under "other withdrawals" or
"other transactions." You will not receive your original check
back from your financial institution. For security reasons, we will destroy
your original check, but we will keep a copy of the check for record-keeping
purposes.
Your Rights:
You should contact
your financial institution immediately if you believe that the electronic
fund transfer reported on your account statement was not properly authorized
or is otherwise incorrect. Consumers have protections under Federal law
called the Electronic Fund Transfer Act for an unauthorized or incorrect
electronic fund transfer.
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