Pharmacy Staffing Services - Request Form

If you are interested in PRS Pharmacy Staffing Services, please use the form below for staffing requests. For more information about our staffing services...We invite you to contact us at 1-800-338-3688.

In order for your request to be submitted, make sure that required fields indicated with a are completed.

Name
 Phone Number
Your Title
Pharmacy Name
 Fax Number
Address 1
Address 2
 Email Address
City
State
 Retype Email Address
Zip Code
Please select which type of pharmacy you are:
Retail Chain Hospital Other
If Other, please explain
Please enter the dates you need coverage:
 
Please enter the shifts you need coverage:
Please enter the computer system at the location in question:

Do you need our pharmacist to run the computer? Yes No
How did you hear about PRS?
If Other, please explain
Please enter any additional information or comments: