Corporate Partnership Form
Set up a vaccine clinic or pharmacy services relationship with The Medicine Shoppe of Shillington.
Full Name
*
E-mail
*
Phone Number
*
-
Area Code
Phone Number
What is your title at the organization.
Organization Name:
*
Address of the organization
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Number of team member interested in selected services.
*
Which Pharmacy services would your organization will be interested?
On-Site Flu and/or COVID-19 vaccination clinic (Direct Pay)
On-Site Flu and/or COVID-19 vaccination clinic process via insurance
On-Site COVID-19 Testing for companies gathering (Direct Pay)
Pharmaceuticals direct contracting
Pharmacy Benefit Manager (PBM) selection consultation
Any comments or messages
SUBMIT
Should be Empty: