Please bring an appropriate vehicle for the size of the request. Trucks or SUVs are recommended when picking up PPE.
Name of Facility
Name of Requestor
State supply availability changes weekly
20/box or 960/case
20/box or 120/case
200 per box, smalls boxes.
Smalls Limited Quantity
Xtra Small only Latex available
List quantity of each size requested
Must send valid CLIA waiver to [email protected]
Depending on the size and availability of the order.
This field is not part of the form submission.
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