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Assisted Living and Home Delivery

assisted-living-dispill-packsAndrews Pharmacy, offers a medication management program to assisted living facilities and to individuals within the community setting. This service is called the A.I.M. System. (Andrews Individualized Medication management system). With this service, we fill and automatically deliver all the customers’ prescriptions in a customized blister pack that makes taking the right medication at the correct time easier than ever!

Our full service pharmacy can accommodate every resident’s prescription and non-prescription needs including:

  • Customized packaging
  • Automatic weekly delivery
  • Prospective and retrospective drug utilization review
  • Training and education for assisted living staff
  • Acceptance of all major insurance plans

 

Complete our Form below to Establish an account:

* Required Fields

Order Information

Patient Name*

Patient DOB*

Male or Female

Date to Start Med Pack*

Is it Assisted Living or Home Delivery?

Assisted Living Information

Name of Assisted Living*

Room Number*

Address Street 1*

Address Street 2

Address City*

Address State*

Address ZIP*

Contact Person*

Relation to the Patient*

Contact primary phone number*

Contact secondary phone number

Contact email

Power of Attorney

Health Care Proxy

Guardian

Patient's Insurance Information

RX BIN #*

RX GROUP #*

RX PCN #*

Cardholder ID #*

Patient Social Security Number

Primary Care Physician Name Primary Care Physician Phone Number

Add Additional Physicians

Any allergies?

Allergy Description

Add Allergy

Do you take medications? Include over the counter medications and vitamins

Name Strength Quantity
You may use decimals		 Notes
Morning:
Noon:
Evening:
Bedtime:

Add Medication

Billing Address Street 1*

Billing Address Street 2

Billing Address City*

Billing Address State

Billing zip*

Billing address same as shipping address

Shipping Address Street 1*

Shipping Address Street 2

Shipping Address City*

Shipping Address State

Shipping Zip*

Credit Card Number*

Credit Card Verification Code*

Name on Card*

Credit Card Expiration Month

Credit Card Expiration Year

I Authorize Andrews Pharmacy to bill my credit card on a recurring basis for all products and services