See if Mosaic Right For you!

This form is designed to be quick and easy.

We'll start with a few questions to check whether you may be eligible for our pharmacy services.

Why are we asking for this information?

To check your eligibility, we need to learn about your Medicare and insurance coverage. We’ll also ask whether you need help with medications, personal care, moving around, daily activities, or tasks at home.

Your answers help us understand whether Mosaic Pharmacy Service can meet your needs.

What Happens Next?

First, you'll answer a few eligibility questions. If it looks like you may qualify, we'll ask you to complete the rest of the intake form so our team can review your information and contact you about the next steps.

Once you submit, the patient will receive a phone call from our Mosaic team at (888) 818-6337. For RxAnte and Mosaic employees submitting a form on behalf of a friend or family member, you are confirming you have consent to share their personal health information with Mosaic and for Mosaic to call, text and email them.

For friends or family members of RxAnte and Mosaic employees, by providing your email and phone number, you are providing consent for Mosaic to text and email you. Read our privacy policy for more information.

This referral program is intended solely to connect individuals who may benefit from Mosaic Pharmacy's services. No referral fees, gifts, incentives, or other compensation are provided to employees, friends, or family members for submitting a referral.