Study Drug Orders

Complete the form below to order study drugs for Hoosier Cancer Research Network studies.

If you have any questions, please contact the HCRN project manager for your study or call our offices at 317-921-2050.

Name
First Last
Institution*
Shipping Address*
Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Phone*
Date Needed
MM slash DD slash YYYY
FedEx or UPS Account Number
For expedited shipping (delivery within five days from today), please provide your FedEx or UPS account number.
Study Number
Select the study and the drug and dose level you wish to order.
Please allow 10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
How many bottles of cabozantinib do you currently have in inventory (available to be dispensed)?*
Please specify number of bottles for each dosage (20mg, 40mg, and 60mg).
Adagrasib 200mg
Enter number of bottles. Orders will be sent within 7-10 business days. Urgent requests require a FedEx number from site.
Atezolizumab 1200mg vials
Enter quantity.
Atezolizumab 1200mg/20mL
Enter quantity.
Balstilimab (agen2034) 50mg/mL
Enter vial quantity. Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
Botensilimab (agen1181) 50mg/mL
Enter vial quantity. Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
Current Number of Balstilimab vials in site/pharmacy inventory
Current Number of Botensilimab vials in site/pharmacy inventory
Cabozantinib 20mg tablets/ 30 tablets per bottle
Enter quantity.
Capecitabine 500mg bottles
Enter quantity.
Durvalumab 500mg
Enter quantity.
Durvalumab 500mg vial
Enter quantity. Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
Enfortumab vedotin 20 mg vial
Enter quantity. Please allow 5-7 business days for shipment.
Epcoritamab 60mg/ml vial
Enter quantity. Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
Epcoritamab 5mg/ml vial
Enter quantity. Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
GT103 20mg/mL
Enter quantity. Please allow 7-10 business days for delivery.
Inavolisib 3mg bottles
Enter quantity.
Inavolisib 9mg bottles
Enter quantity.
Lutetium Lu 177 will be ordered by site study coordinators. If you have any questions about this IP, please contact HCRN Project Manager Kimberly Cameron at kcameron@hoosiercancer.org.
Lenvatinib 8mg (carton)
Enter quantity.
Lenvatinib 10mg (carton)
Enter quantity.
Lenvatinib 14mg (carton)
Enter quantity.
Lenvatinib 20mg (carton)
Enter quantity.
Monalizumab 375mg vial
Enter quantity.
Monalizumab 750mg vial
Enter quantity. Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
Nivolumab 100mg
Select the number of vials you are ordering.
Neratinib 40mg tablets (210 ct bottle)
Enter quantity.
Olaparib 100mg tablets (60pills/bottle)
Enter quantity.
Olaparib 150mg tablets (60pills/bottle)
Enter quantity.
Pacritinib 100 mg capsules/120 ct. bottles
Enter number of bottles. Please allow 10-14 business days for processing and delivery.
How many units does your site currently have in inventory (available to be dispensed)?
Pembrolizumab 100mg/4mL (vials)
Enter quantity. Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
XL092 40 mg blue film-coated tablets
Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
XL092 60-mg blue film-coated tablets
Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
XL092 100-mg blue film-coated tablets
Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
Pembrolizumab 100mg/4mL (vials)
Enter quantity. Allow 7-10 days for delivery.
Pembrolizumab 100mg/4mL vial
Enter quantity. Please allow 5-7 days for shipment.
Pembrolizumab 100mg
Enter quantity. Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
Pembrolizumab (vial)
Enter quantity. Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
Pembrolizumab (1 vial)
Solution for Infusion 100mg/vial . Enter quantity. Please allow 7-10 business days for delivery. Failure to meet this timeline may result in delivery/shipping delays.
Ramucirumab 100mg/10mL
Enter quantity.
Ramucirumab 500mg/50mL
Enter quantity.
Regorafenib 30mg bottles
Enter quantity needed. Orders will be sent within 7-10 business days. Urgent requests require a FedEx number from site.
Ribociclib 200mg (42 tablet carton)
Enter number of cartons. Each carton contains 3 blister packs. East blister pack contains a 7-day supply of 14 tablets (200mg per tablet; 400mg daily dose).
Ribociclib 200mg (21 tablet carton)
Enter number of cartons. Each carton contains 1 blister pack. East blister pack contains a 21-day supply of 21 tablets (200mg per tablet; 200mg daily dose).
Talazoparib 0.25mg bottles
Enter quantity.
Talazoparib 1mg bottles
Enter quantity.
Tremelimumab 25mg/vial
Enter quantity.
Tucatinib 50mg - 60 count*
Enter quantity. Bottles contain 60 tablets. Please allow 7-10 business days for delivery.
Tucatinib 150mg - 120 count*
Enter quantity. Bottles contain 120 tablets. Please allow 7-10 business days for delivery.
Tucatinib 150mg - 60 count*
Enter quantity. Bottles contain 60 tablets. Please allow 7-10 business days for delivery.
Current Number of Tucatinib 50mg - 60 count bottles in site/pharmacy inventory*
Current Number of Tucatinib 150mg - 120 count bottles in site/pharmacy inventory*
Current number of Tucatinib 150mg - 60 count bottles in site/pharmacy inventory*
Number of patients on dose reductions*
Comments
Email
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