Pharmaceutical Services Negotiating Committee

Feedback Form

Please complete the feedback form below to report problems experienced in obtaining branded medicines due to Manufacturer’s quota schemes. PSNC will work to ensure this information is fed into the Department of Health as evidence of the ongoing supply problems being reported by pharmacy contractors.

Branded Medicine Shortages

Name of Pharmacy *

Name *

Postcode of Pharmacy *

Country *

Email *

Wholesaler / depot *

Other details of wholesaler or depots

Product *
(Please also indicate the strength and form here)

Manufacturer *

If other, please specify

Time to obtain product *

Summary of problems occurred in obtaining product
(please fill in as much detail as possible)

Impact of supply issue
(please fill in as much detail as possible)

Please check the box if you consent to PSNC passing on your contact details to the relevant manufacturers if they would like to investigate the report further

* Denotes required field.