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Customer Information Form
Specialty Distributions & Specialty Pharmacies
Request a Return
Contact Info
Return Request Form for Customers
All fields are mandatory.
Alexion Customer Operations Specialist Name: (COS name)
Pharmacist/Buyer (or purchaser) Name
Email
Phone Number
Facility Name
Address
ZIP Code
Detailed Description of Event: (Reason for Request)
Packing List Info Needed
Purchase Order #
Lot #
Expiration Date
Product
Vial Quantity
Date of Event
Date of Contact: (first outreach to Customer Operations team)
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