COVID-19 Vaccine Waitlist

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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 Arkanas Deparment of Health Vaccination Plan Map. The Arkansas Deparment of Health Vaccination Plan Map can be viewed here

Currently, Southern Pharmacy - Marked Tree is not accepting COVID-19 Vaccination Appointments due to vaccine availability

Please complete the COVID-19 Vaccine Screening Form to be notified when you may be eligible for COVID-19 Vaccination

Click NEXT to continue
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Have you received you first dose of COVID-19 vaccine?
YESNO
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If yes, select which COVID-19 vaccine you received for your first dose?
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 CDC/ACIP recommendations for Phase 1b/1c COVID-19 vaccine distribution
Healthcare Workers
Adults greater than 70 years of age
K-12 Education Staff
Higher Education Staff
Daycare Staff
Other
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Are you a member of one of the following groups?* This field is required.Groups based on CDC/ACIP recommendations for Phase 1b/1c COVID-19 vaccine distribution
Adult between 65 and 70 years old
Adult 16-64 with Certain Medical Conditions (Cancer, Kidney Disease, COPD, Down Syndrome, Heart Conditions, Immunocompromised, Obesity [BMI > 30], Pregnancy, Sickle Cell Disease, Smoking, Type 2 Diabetes)
Adult 16-64 with Other Medical Conditions (Asthma, Cerebrovascular Disease, Cystic Fibrosis, High Blood Pressure, Neurological Conditions [Dementia], Liver Disease, Overweight [BMI > 25 and < 30, Type 1 Diabetes)
Food Industry (Meat Packing and Grocery)
Utility Workers
Truck Drivers
Essential Government and Infrastructure Workers
US Postal, Fed Ex, UPS, or other package delivery
Manufacturing
Agriculture
None of these
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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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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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