Confirmation of Receipt of Drugs CRS-AIDSRelief Program LPTF Confirmation of Receipt of Drugs and Other Medical Supplies LPTF
Date Received
To: The Health Supply Chain Specialist CRS-AIDSRelief Program
Product Code
Product Description
Form
Amount Strength Pk. Size Requested
Prepared By: Name: Title: Sign: Date:
45
Amount Received
Batch No.
Mfg. Date
Exp. Date