Field of employment (healthcare workers, essential workers, etc.)
If you don't meet your state's eligibility criteria for a COVID-19 vaccination, you are not eligible to receive a vaccination at this time.
How it works
Register at rxAssist pharmacy website.
Complete a short screening
If you're eligible, you'll be able to schedule appointments for both your Dose 1 and Dose 2 vaccination at the same time.
If you feel ill on the day of your vaccination, please reschedule your appointment when you feel health and well.
For your appointment, please arrive 15 minutes early and bring the following:
Your appointment confirmation email
Your state ID, valid driver's license or other government-issued ID
Your medical, pharmacy benefit or medicare insurance card
If uninsured answer the question below to attest,
Please Note:In order to have your vaccine administration fee paid for by the United States Health Resources and Services Administration's COVID-19 Program for Uninsured Patients, please provide either (A) a valid Social Security numer, (B) State Identification number and state of issuance, OR (C) A driver's license and the state of issuance.
CONSENT FOR SERVICES: I have been provided with the Vaccine Information Sheets(s) or patient fact sheet corresponding to the vaccine(s) that I am receiving. I have read the information provided about the vaccine that I am to receive. I have had the chance to ask questions that were answered to my satisfaction. I understant the benefits and risk of vaccination and I voluntarily assume full responsibility for any reactions that may result. I understand that I should remain in the vaccine administration area for 15 minutes after the vaccination to be monitored for any potential adverse reactions. I understan if I experience side effects that I should do the following: call pharmacy, contact doctor, call 911. I request that the vaccine be given to me or the persone named above for whom I am authorized to make this request.
DISCLOSURE OF RECORDS: I understand that rxAssist pharmacy may be required to or may voluntarily disclose my health information to the protocol physician, my primary care physician, my insurance plan, health systems and hospitals, and/or federal registries, for the purpose of treatment, payments, or other healthcare operations. The disclosure will used as set forth by rxAssist Notice of Privacy Practice.