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.

As of March 30, 2021, all Arkansans greater than 16 years of age are eligible to receive COVID-19 vaccines

Please complete the COVID-19 Vaccine Screening Form. You will me contacted by a Southern Pharmacy staff member to schedule your COVID-19 vaccine appointment.

Click NEXT to continue
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Have you received you first dose of COVID-19 vaccine?
YESNO
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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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EmailEmail 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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