If you have clients who you believe may qualify for service at the SVdP Georgia Community Pharmacy, please submit a Client Eligibility Application to begin a referral.
Please read the steps below and the FAQ before submitting an application.
If you have additional questions about the pharmacy or would like to volunteer, please contact Samantha Ricks at email@example.com or 678-892-6181.
WE ARE EXPERIENCING A HIGH REFERRAL VOLUME WHICH MAY CAUSE DELAYS IN OUR RESPONSE. PLEASE KNOW THAT WE ARE WORKING THROUGH EACH REFERRAL AS SOON AS WE CAN.
TO HELP YOUR REFERRAL PROCESS SMOOTHLY, PLEASE ENSURE YOU HAVE SUBMITTED ALL OF THE INFORMATION REQUESTED ON THE REFERRAL FORM.
***INCOMPLETE REFERRALS WILL BE DELAYED.
How to Make a Referral
- Identify client in need through traditional home visit casework.
- You may wish to print and use this data collection form during your home visit to obtain the necessary information for the pharmacy application.
- Search the Formulary List to see if their medications are eligible. If you are unable to complete the Formulary search, you can still submit the Pharmacy Referral Form with the required information marked with an asterisk (*) .
- Submit the online referral application below on behalf of your client.
- A representative from the pharmacy will review the application and reach out to the client to schedule an appointment. Phone and in-person appointments will be scheduled for Monday, Tuesday and Thursday: 9:00 AM- 3:00 PM except for lunch: 12:00 PM- 12:30 PM and holidays.
- Enter referral via CMS. (Click Here for Step by Step Instructions)
The SVdP Georgia Community Pharmacy is a fully licensed charitable pharmacy with a mission to provide prescription medications and wellness education for those in need by providing prescribed maintenance medications to low-income individuals.
Maintenance Medications will be available for the following conditions:
- Mental health conditions
- Chronic respiratory conditions such as asthma and COPD With the hopes of expanding the number of clients SVdP Georgia serves, the SVdP Georgia Community Pharmacy will help uninsured adults with low incomes throughout the state of Georgia with a compassionate resource to fill current prescriptions for free or low- cost and ensure safe and effective use of medicine.
The pharmacy will serve clients 18 + who present a valid prescription.
The pharmacy will also assist undocumented individuals.
Click Here for a Data Collection Form that contains all of the information you will need to obtain from your client prior to starting the referral application. You can print this out and take it on your home visit.
MAKE A REFERRAL FOR YOUR CLIENT TODAY!
Please complete this Client Eligibility Application (Referral)
If you have questions about this application please contact us at firstname.lastname@example.org.