Ambulatory Care & Outpatient Pharmacy Resources
14 MP Outpatient Pharmacy Resources  
               General Information

Hours of Operation & Contact        Information

340B Eligible Physician Practices

- HIPPA Release Form


- Administration Record, Screening, &     Patient Consent Form

- Spanish Form 

    Concierge Pharmacy Service Resources 

PH Concierge Pharmacy Services Tutorial Video

     - Concierge Service Form - Baptist 

     - Concierge Service Form - Richland


         Finanacial Assistance Programs           (FAP)

- FAP Directions

- FAP Formulary

Finanacial Assistance for Diabetic Supplies

- Welvista Medication Assistance Program

- NeedyMeds

Employee Rx Plan

- Abridged Standard Formulary

     - Standard Supplemental Formulary

High Deductible Health Plan:

     - Preventive Therapy Drug List

     - HDHP Supplemental Formulary

- Preventive Service Coverage

- Mail Order Enrollment Form (90-Day Rx Program)

- Outpatient Pharmacy Courier Request Form -       
Parkridge/Colonial Life Employees

Ambulatory Care Resources
Patient Education:
     - Smoking Cessation
      - After Hour Pharmacies

Transition of Care:
     - ASHP-APhA Care Transitions Best Practices
     - C-TraC (Coordinated Transitional Care)
     - Care Transitions
     - BOOST (Better Outcomes by Optimizing
       Safe Transitions)
     - National Transitions of Care Coalition

 Patient Assistance Programs (PAP)

- Cardiovascular Agents

- Direct Oral Anticoagulants (DOACs)

- Inhalers

- Injectable Diabetes Medications

- Oral Diabetes Medications

- Xifaxan (rifaximin)

      - Xifaxan (rifaximin) Insurance      
        Verification Form

- Smoking Cessation

                     Insurance Resources

- FingerTip Formulary

10 MP Outpatient Pharmacy Resources  

This site is intended for the staff of Prisma Health-Midlands.
While others may view accessible pages, Prisma Health-Midlands makes no warranted, expressed or implied,
use of this information outside of Prisma Health-Midlands.