Pharmacy & Health Services, Inc.

(941) 445-5687                     facebook.com/goodsamrx

Good Samaritan

Patients can apply for services by calling 941-445-5687 for pre-screening to determine eligibility.  Alternatively, patients can download a GSPHS Patient Assistance Application from this website.   Use the link below to download an application form.  The application can be dropped off at the Nokomis office or faxed to GSPHS at  941-445-5688.  Once your application has been submitted a volunteer will contact you to follow-up.  

A few helpful points:

  • Clients need to be a legal resident and have a photo ID.
  • Clients must have no medication or prescription insurance.
  • Client must have proof of income.  Proof of income may include:  Last 4 weeks pay stubs, Social Security Benefits letter, Zero Income Letter and Letter of Support, etc. (volunteer advocates can assist in getting these forms if needed). 
  • Copy of latest tax return or non-filing letter.

APPLY FOR SERVICES