Pharmacist checks out medication.

Specialty Pharmacy

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Specialty Pharmacy Acknowledgement Form

If you are unable to complete your Specialty Pharmacy Program acknowledgement form and return it by mail as outlined in the program welcome packet, please complete the form electronically below.

By filling in the requested information below and clicking ‘Submit Form’, you acknowledge that you:

  • Received a University of Mississippi Medical Center (UMMC) Specialty Pharmacy Welcome Packet
  • Received and carefully read the UMMC Specialty Pharmacy Welcome Packet, including sections regarding program contact information, pharmacy hours of operation, and your rights and responsibilities as a patient at UMMC
  • Understand your rights and responsibilities as a patient at UMMC Specialty Pharmacy

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