ABCDEFGHIJKLMNOPQRSTUVWXYZ
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Entity Name/Clinic Site of Care
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Manual Dispense Tracking Log
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Enter Medication Name, NDC (1 Med per page), JCODE
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Beginning Balance of Medication Units: _____________
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Medication IN:
Invoice Number 		Medication OUT:
Patient ID/Chart # 		Date Dispensed/ Administered OR ReceiviedQuantity ( - ) Dispensed/ Administered OR ( + ) Received(=) Total On HandRouteLot #Expiration DateNurse or Designee Provider NameDate and Name Reconciled Log On Hand Actual On Hand
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DIRECTIONS FOR TRACKING PROCESS:
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• State provider dispensing laws should be followed for all processes.
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• Each new page should be pre-populated with the Medication name, NDC and JCODE if appropriate at the top of the page.
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• Each new page should be started with the quantity remaining on the previously used page.
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• Nurse Manager or designee orders medications from wholesaler order system.
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• Medications received are entered into tracking sheet with Invoice number, NDC, Quantity, Lot #, Date received
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• When a product is requested by a provider, Nurse, or designee, selects appropriate tracking sheet by Drug Name and NDC and enters data for dispensation and the remining total on hand after dispendation.
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• Data may also entered in patient record in EMR if appropriate.
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This tool is written to align with Health Resources and Services Administration (HRSA) policy, and is provided only as an example for the purpose of encouraging 340B program integrity. This information has not been endorsed by HRSA and is not dispositive in determining compliance with or participatory status in the 340B Drug Pricing Program. 340B stakeholders are ultimately responsible for 340B program compliance and compliance with all other applicable laws and regulations. Apexus encourages all stakeholders to include legal counsel as part of their program integrity efforts.
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© 2018 Apexus.  Permission is granted to use, copy, and distribute this work solely for 340B covered entities and Medicaid agencies.
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