Covid-19 Vaccine

Beaver Health Mart Pharmacy will be administering COVID19 vaccines as they are available. We will follow guidelines from the Pennsylvania Department of Health for vaccine administration

If you are interested in being on our COVID19 vaccine list, please complete the COVID19 Vaccine Request Form. We will place you in the appropriate phase and contact you via email when the vaccine is available for you. Be sure to provide a valid email address, as this is the preferred method of contact to schedule you for your vaccine administration. The vaccine administration phases are dynamic, and we will contact you when you are eligible and the vaccine is available. Please do NOT call the pharmacy, as completing this form will automatically add you to the list.

Covid-19 Vaccine Request Form

  • Date Format: MM slash DD slash YYYY
  • REQUIRED. This is how you will be contacted to receive your COVID19 vaccine when you qualify for the appropriate phase
  • Please answer any call from Beaver Health Mart Pharmacy 724-774-0919 as we will not be able to make multiple calls based on the high demand for the COVID19 vaccine. A missed call may lead to being moved on the vaccine list
  • * Required field necessary before submitting.