SVdP Georgia Community Pharmacy Eligibility & Request Form
Who Is Eligible
Eligibility for pharmacy services is determined on the basis of income and expenses. The SVdP Georgia Community Pharmacy serves eligible patients with an income no greater than 200% of the federal poverty level (fpl) and uninsured individuals 18 years of age and older that live within the state of Georgia and have a valid prescription(s) for the medication needed. Once a patient submits an online prescription request form, the SVdP Georgia Community Pharmacy staff will check to confirm eligibility.
HOUSEHOLD SIZE/MONTHLY INCOME CHART
Use this chart to determine if you are eligible for SVdP Georgia Community Pharmacy services. For questions regarding your eligibility, contact firstname.lastname@example.org.
FILLING OUT AN APPLICATION IS QUICK & EASY
Please fill out the form below and our pharmacy team will be in touch!
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3 WAYS TO RECEIVE YOUR PRESCRIPTION MEDICATION
- Prescription pick-up at the St. Vincent de Paul Georgia Community Pharmacy at 2050 Chamblee Tucker Road Atlanta, GA 30341.
- Free prescription medication delivery within 20 miles of St. Vincent de Paul Georgia Community Pharmacy.
- Free shipping of prescription medications across Georgia through UPS.
Contact the St. Vincent de Paul Georgia Community Pharmacy at email@example.com. To submit an application, fill out the form above.