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Fentanyl Awareness & Narcan Access Supply Order Form

Erie County Businesses and Community Organizations:

As supplies are available, the Erie County Department of Health (ECDOH) Opioid Program has several FREE items available to you! 

Please use this form to order the supplies you would like.   

For additional information or questions, please call 716-858-7695.  

See this flyer for pictures and a detailed description of each item.  

Type of Business
Business or Organization Address
Contact Name

Large Paper Bags - The perfect size for take out or leftovers ( 13"x13"x 9"; packs of 50)

Would you like to order large paper bags?

Removable Window Decal (Packs of 10)

Would you like to order a window decals?

Coasters (Packs of 50)

Would you like to order coasters?

Narcan Wall Box (Single Box)

Narcan wall box

Would you like to order a Narcan wall box?

Condoms (Condom bowl filled with condoms)

Would you like to order condoms?

Open Stand - Initial order includes the stand, 24 Narcan, 50 Test Strips and 10 Sharps containers

Opiate program open stand

Would you like to order an open stand?
If your organization already has an OPEN stand, would you like to order a refill?
Would you like to schedule a Narcan/Naloxone training for your organization or community?
Would you like information on literature available for distribution at your organization?

Thank you for your interest.  If we have questions about your order, we will contact you.  Please allow a few weeks for your items to be delivered.