Applications and Forms


Access most commonly used forms and applications.

Code Verification

Read instructions, complete, and review the checklist within each application to ensure corresponding documentation/applicable product sample is included with submission.

Effective July 1, 2019, PDAC will only accept the applications listed below.

View the Code Verification Request Application Instructions webpage for application instructions.

DMECS

  • Manufacturer Name Change (PDF, 13 KB)  - Attestation regarding Manufacturer name change resulting from a corporate merger/purchase
  • Model Number Addition (PDF, 13 KB)  - Attestation regarding addition of model numbers. Must print/submit on company letterhead. Submit product literature and effective begin date for new product(s)
  •  Private Label Agreement – Distributor Attestation (PDF, 16 KB) - Attestation Regarding Addition of New Manufacturer/Distributor Name Resulting from Private Label Agreement – Distributor Attestation
  • Private Label Agreement – Manufacturer Attestation (PDF, 16 KB) - Attestation Regarding Addition of New Manufacturer/Distributor Name Resulting from Private Label Agreement – Manufacturer Attestation

Contact

  • DME PDAC Contact - Submit an email to PDAC for answers to coding and product inquiries

Articles


Last Updated: 12/17/2018