COVID-19 Vaccine Appointment Request

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Southern Pharmacy, in coordination with the Arkansas Department of Health, will be a participating COVID-19 vaccine provider. Vaccine distribution will follow the Arkansas Department of Health Vaccination Plan Map. The Arkansas Department of Health Vaccination Plan Map can be viewed here.

Please complete the COVID-19 Vaccine Appointment Request to schedule a COVID-19 vaccination

Click NEXT to continue
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Have you received you first dose of COVID-19 vaccine?* This field is required.
YESNO
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If yes, select which COVID-19 vaccine you received for your first dose?* This field is required.
Pfizer COVID-19 Vaccine
Moderna COVID-19 Vaccine
I Do Not Remember
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Are you a member of one of the following groups?* This field is required.Groups based on ADH recommendations for Phase 1a/1b COVID-19 Vaccination Plan
Healthcare Workers
Adults greater than 70 years of age
K-12 Education Staff
Higher Education Staff
Daycare Staff
Other
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According the Arkansas Department of Health Vaccination Plan Map, you are not eligible for COVID-19 vaccination at this time. If you have questions regarding the Arkansas Department of Health Vaccination Plan, please contact Southern Pharmacy at 870-972-1751 or care@southernpharmacy.net.

You can signup to be notified when you are eligible for COVID-19 vaccination by completing the COVID-19 Vaccine Screening Form

Click SUBMIT to be taken to the COVID-19 Vaccine Waitlist Form
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Southern Pharmacy is not currently scheduling appointments for first dose COVID-19 vaccinations. If you received your first dose from Southern Pharmacy - Jonesboro, please answer Yes to "Have you received you first dose of COVID-19 vaccine?" to schedule your second dose of COVID-19 vaccine.

If you have not received your first dose of COVID-19 vaccine, you can be added to the COVID-19 Vaccine Waitlist. You will be notified when COVID-19 vaccine doses are available.

Click SUBMIT to be taken to the COVID-19 Vaccine Waitlist Form
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Name* This field is required.
First Name
Last Name
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Phone Number* This field is required.
Area Code
Phone Number
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Email* This field is required.Email will be used to confirm appointment time and other information regarding COVID-19 testing.
example@example.com
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COVID-19 Vaccine Appointment Time* This field is required.Please select a Test Appointment Time
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Consent to Notify: I consent that Southern Pharmacy may contact me via email and/or sms message using the information provided. Contact information may include COVID-19 vaccine availability, COVID-19 vaccine appointment reminders, and other healthcare information.

View the Southern Pharmacy privacy policy here

Please click SUBMIT to verify consent
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