Safe Medication Disposal
Program Application

1. Provide Contact Information

2. Program Essentials

3. Review and Submit Application

Please verify that all the information below is correct before submitting the form.

Law Enforcement Agency

(The physical location of the agency must be located within 20 miles of a Rite Aid store to be eligible to participate in the program.)

Chief of Police (or corresponding responsible party, e.g. "Sheriff"):

Person managing the medication disposal program at law enforcement agency:

(Must be an employee of the law enforcement agency applying.)

Person completing application:

Terms & Conditions

By submitting this application:

  1. Law Enforcement Agency agrees to accept receptacle.
  2. Law Enforcement Agency is responsible for ongoing costs incurred to maintain the unit and to destroy the drugs collected.
  3. Law Enforcement Agency agrees to weigh and record the amount of drugs collected on an ongoing basis. American Security Cabinets will reach out to collect this data approximately every 6 months on an ongoing basis.
  4. Law Enforcement Agency acknowledges that Rite Aid pharmacy locations in the vicinity will support awareness of the receptacle by promoting the drug collection program.
  5. Law Enforcement Agency agrees to adhere to the Drug Enforcement Agency's rules and regulations concerning Drug Take-Back.

Any and all liability arising from the installation of the receptacles or the collection and/or destruction of the drugs deposited in the receptacles will be the sole responsibility of the agency that accepts the receptacles (the "Agency"). Rite Aid Foundation/KidCents ("Foundation") will not be liable for, and the Agency, to the extent permitted by Law, will indemnify, defend, and hold Foundation harmless from and against any claim, injury, damage, loss, expense, demand, or judgment in any way resulting from any acts or omissions by the Agency in the use of the receptacles or the collection and/or destruction of drugs deposited in the receptacles.