Infused Products Dispensing Customer Return Goods Request

If you have any questions or concerns related to this return policy or status, contact Bristol Myers Squibb Customer Service:

E-mail: customerserviceoperations@bms.com Phone: 1-800-631-5244

* - Required Field For assistance or FAQ's, click here

Contact Information

Requestor Name:*

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Requestor Position:*

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Company Name:*

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Address:*

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City:*

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State:*

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Zip:*

Phone:*

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Phone Extension:

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E-Mail:*

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Original Purchase Information

Wholesaler Name:*

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Wholesaler Location:*

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Wholesaler Account:*

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* One Invoice number per submission

Invoice Number:*

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Invoice Date:*

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PO Number:*

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Date loss occurred:*

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Date of loss should not be less than Invoice date

For this invoice, were you eligible for a government program or government contract related discount?*

Yes

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Return Information

Reason for Return:*

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Patient unavailable to receive as a result of illness/death

Patient unavailable to receive when patient refuses treatment

Patient unavailable to receive due to adverse event

Patient ineligible for treatment.

Compromised refrigeration (i.e. left out)

Mishandling of the drug (i.e. dropped vial, incorrect mixing)

Unopened product not accepted by wholesaler or specialty distributor due to distributor’s determination of potential compromise of product integrity

* To add product, enter product details in boxes below and then click on “Add Selected Item”. You must repeat this process for each product/batch/serial number that you are requesting to return on this invoice.

* Serial number is identified by “S/N”. It should be 12 or 13 digits and it is all numeric.

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Please enter atleast 12 or 13 digits

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Add a product

Select a product to delete

Please upload a scan of the invoice in pdf, jpg or png format. Size limit - 4 MB.

Any information related to products supplied by another manufacturer can be redacted.

Upload Invoice*

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The undersigned here by certifies that the information provided in this form is true and correct. The undersigned further certifies that the vial(s) for which a return is being requested have not been and will not be administered in whole or in part, that no reimbursement has or will be sought in connection with the vial(s) for which a return is being requested, and that the vials will be made available for pick-up by BMS (if unopened) or appropriately discarded in accordance with applicable requirements for the disposal of medical waste (if opened/mixed/damaged).

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Confirmation Message

Your request has been submitted successfully

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