Forms

Employment Application

If you are interested in employment opportunities with Eastridge-Phelps Pharmacy, LLC,

  • Click the Download Employment Application button below
  • Print the Employment Application
  • Complete the Employment Application
  • Present the application in person to one of our two locations

Eastridge-Phelps Pharmacy

500 N. Bypass

Campbellsville, KY 42718

Eastridge-Phelps Pharmacy

460 Commerce Drive

Greensburg, KY 42743

Vaccination Consent & Assessment Form

For Vaccinations provided by Eastridge-Phelps Pharmacy:

  • Click the Download Vaccination Consent & Assessment Form button below
  • Print the Vaccine Consent and Assessment Form
  • Complete the Vaccine Consent and Assessment Form
  • Present the form to our pharmacy for vaccination

Patient Services Referral Form

For Patient Services Referral to Eastridge-Phelps Pharmacy:

  • Click the Download Patient Services Referral button below
        Patient Services available:
        *Medication Delivery Services
        *Mediplanner (multi-dose medication compliance packaging)
        *Prescription Savings Review (Medicare Part D, Formulary review)
        *MedSync (synchronization of medications for once-a-month pick-up)
        *Blood Glucose Counseling and Monitoring
        *Blood Pressure Counseling and Monitoring
        *Transition of Care (medication reconciliation, formulary review, care coordination, etc.)
        *Chronic Care Management Services
        *CBD Oil Consultation/Dosing
        *Customized patient care services

Eastridge-Phelps Pharmacy

500 N. Bypass

Campbellsville, KY 42718

(270) 789-0578

Eastridge-Phelps Pharmacy

460 Commerce Drive

Greensburg, KY 42743

(270) 299-2334