Contact Us

Mosaic is a pharmacy designed for patients taking multiple medications to manage chronic conditions. To learn more about our service and to see if you qualify, please complete the form.

Contact Us to Discuss Your Pharmacy Needs

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Contact Page Form

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For timely and accurate pharmacy assistance, call (888) 818-6337.

Our pharmacists are available 24/7 to provide immediate guidance on medications, prescription changes, side effects, and other pharmacy-related updates.

If this is a medical emergency, please call 911 or your local emergency number immediately.

Who is this request for?

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Patient Full Name:*

First Name Last Name

Patient Phone Number:*

Patient Email:

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Patient Address / Location:*

Residence

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Location

Name and contact information of the patient being referred:*

Organization*

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Inquiry

Other Notes

Once you submit, you will receive a phone call from our Mosaic team at (888) 818-6337. By providing your email and phone number, you are providing consent for Mosaic to text and email you. You can opt out at any time. Read our privacy policy for more information.

Referral Information

Your Full Name:*

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Your Relationship with the Patient*

Reason for referral?

How many medications are currently being taken by the patient?

How many medications do you take?

What health plan does the patient use?

What health plan do you use?

How did you hear about us?