Get on the COVID-19 Vaccine Waitlist!
Once you fill out this form, we will add you to the waitlist, and you will be contacted about COVID-19 vaccine when it is available at our pharmacy. We appreciate your patience.
The Category You Fall In
Please Select
Healthcare Worker
Essential Worker
16-64 with Chronic Health Condition
Age 65-69
Age 70+
Teacher/Educator
Other
Preferred Location
Please Select
Westchester
The Bronx
Nassau
Broome
Saratoga
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Should be Empty: