Community Health Event

Quality First Pharmacy COVID-19 Vaccination Sign Up Form

Please find the attached intake worksheet and bring completed along with insurance cards, and photo ID to help expedite the administration process. Thank you!

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Created by:   Quality First Pharmacy
 
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Date (mm/dd/yyyy CDT) Location Available Slot
06/18/2021
(Fri. 3:00pm - 5:00pm)
Quality First Pharmacy

Moderna Vaccine (60)

(ages 18 and older)

 
4 of 60 slots filled

Johnson & Johnson Vaccine (60)

(ages 18 and older)

 
5 of 60 slots filled

Pfizer Vaccine (60)

(ages 12 and older)

 
4 of 60 slots filled
06/25/2021
(Fri. 3:00pm - 5:00pm)
Quality First Pharmacy

Moderna Vaccine (60)

(ages 18 and older)

 
3 of 60 slots filled

Johnson & Johnson Vaccine (60)

(ages 18 and older)

 
1 of 60 slots filled

Pfizer Vaccine (60)

(ages 12 and older)

 
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