Ohio Pharmacy Services Survey

The Ohio Pharmacists Association (OPA) is gathering information to build a registry of services pharmacists provide across the state. Information from this registry may be used in discussions with state health plan officials and/or managed care organizations as OPA discusses provider status implementation. Please complete this questionnaire if you would like your information to be part of this registry.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Email *This question is required.

4. Phone Number *This question is required.

5. Company *This question is required.

6. City of employment *This question is required.

7. Zip code of employment *This question is required.

8. Can we share any relevant submitted information to any health plans or state officials who might be interested in your practice setting? *This question is required.

9. What is your title? *This question is required.