Referral Form for Healthcare Provider

Healthcare Provider:

Download the referral form, fax this form and E-Prescribe (e-Rx) all prescriptions
In order to obtain assistance for your patient through our charitable pharmacy program.

(*** A referral will be honored for 90 days upon receipt ***)

Faith Community Pharmacy Physician Referral

Our Formulary

Faith Community Pharmacy Formulary

Current as of 11/02/2020. Formulary 2020 Subject to change.

We do not stock any controlled substances, contraceptives, or narcotics. As much of our stock is supplied through donations, this list is not all-inclusive or exhaustive, and supply fluctuates on all items marked as Limited Supply. Please call with any questions about this formulary or if you wish to inquire about other medications we may have in small supply.

Wish list of Drugs for Donations

Provider offices wishing to donate medications please click here for our wish list. Call us at 859-426-7837 and we will be happy to pick-up donated medications.