home about us my prescription my pharmacist contact us links



Request for Donation or Advertisement


We receive many requests for donations and advertisements in support of charitable causes. While philanthropy is an important part of our mission, the volume of these requests far exceeds our financial capabilities. This form is NOT designed to deter requests, but rather to more fairly divide the amounts we are able to contribute. Please take a few moments to download and to fill out this form. Thank you for your cooperation!

if you don't have Acrobat Reader, click here to download the latest version.