ࡱ>  Root Entry F FQAXObjectPool`HAX`HAXWordDocument 'LMN Ah#$%/0IJ012S$Shh  4h.$Shh 4h.SS j R S    S<#SSSTK @ Normala $@$ Heading 1]c&@"& Heading 2xU]c$@2$ Heading 3xUc">@"Title>]c0 O Body SingleKcbObBullet 1GLh 4hhcbObBullet 2GMh 4hvhc,O,First Line IndentNcfOf Number ListGOh 4h.hc&O& Table Text PclOlOutline (Indented)GQh 4h.hcpO"pOutline (Not Indented)GRh 4h.hc O2 Default TextSc & /yz   STimes New Roman Symbol &ArialWingdings&Arial Black_tvz! "/L) /L) Martin Bennett............... ..................................................... This agreement is not valid until signed by both parties. Co-ordinated Pharmacy Services for Drug Users Copyright Associated Chemists (Wicker) Ltd Page page \* MERGEFORMATa A|.A|. hhhhhhhhh.....)))()A|.ܥe-  z$$$$$ .$>STInjecting Support and Health Promotion Pharmacy Agreement Registration Form Name of Pharmacy: .................................................... Address ................................................. ................................................. ................................................. Post Code ........................... Phone ............................. Fax ......................... Email Address ........................................... Contact Person ........................................ This agreement is between the above pharmacy (The Pharmacy) and the Service Provider for the above scheme - Associated Chemists (Wicker) Ltd of 61 - 71 Wicker, Sheffield S3 8HT Tel 0114 2727 7676 Fax 0114 272 6431 Email: martin@wicker.co.uk Contact: Martin Bennett Services to be provided Syringe and needle exchange scheme for injecting drug users (Injecting Support) - (a) Advice on harm reduction methods and (b) supply of condoms (Health Promotion) The Pharmacy will provide the above services to any Drug User over the age of 16 who self refers to the service. The pharmacist must draw the users attention to the Rules of the Scheme and the user must agree to abide by the rules of the scheme. I have read the attached criteria that apply to joining this scheme. The named pharmacist for this pharmacy is .......................................... Signed Signed .......................................... .................................................... on behalf of the pharmacy on behalf of the Service Provider Print Name..................................... ..................................................... Date ...................................... ..................................................... This agreement is not valid until signed by both parties. Co-ordinated Pharmacy Services for Drug Users Copyright Associated Chemists (Wicker) Ltd Page page \* MERGEFORMATa A|.A|. hhhhhhhhh.....)))()A|.&'KLS_hy&-./0HIJ/012 R S      uU^UVcUVUcVUc$^8