Medical Service Society of San Diego

Medical Service Society of
San Diego

Roster Renewal Form

Click here to read the announcement regarding this form and process.

Step 1: Enter Contact Information

	Pharmacy Name/ Chain Name:
	City:
	Key Contact Person, Name:
	Title
	Email address

Step 2: Choose Pricing Option

		$20 - list pharmacy name & phone
		$25 - list pharmacy name & phone & fax #
			(enter fax # here)

Step 3: Do you wish to add or modify any existing information on the Pharmacy Roster?
No, I do not wish to make any changes to the information posted.
Yes, I would like to make the following additions or modifications.