Pharmacist (PM Shift)

Pharmacist (PM Shift) application form – substantive content extracted and reformatted below.

Licensure & Certification

• Active Ohio Pharmacist License
• DEA Registration (active or pending)
• NPI Number (if applicable)
• Immunization Certification
• MTM (Medication Therapy Management) Certification (optional)
• CPR/BLS Certification (with expiration date if applicable)
• Authorized to work in the U.S.

Education

• Pharmacy degree from an accredited school/institution
• Residency or Fellowship Training (PGY-1, PGY-2, Fellowship, or None)

Professional Experience

• Most recent employer details (job title, start/end dates, supervisor contact)
• Primary responsibilities and practice setting (Retail/Community Pharmacy, Hospital/Clinical Pharmacy, Urgent Care/Ambulatory, Compounding Pharmacy, or Other)
• Permission to contact previous employer

Clinical & Technical Skills

• Medication verification and dispensing accuracy
• Patient counseling and education
• Immunization administration
• Medication Therapy Management (MTM)
• Controlled substance and DEA compliance
• Pharmacy operations and workflow management
• Supervision and precepting of technicians or interns
• EMR/Pharmacy software proficiency (e.g., PioneerRx, Rx30, Epic)
• Insurance billing and prior authorization resolution
• Bilingual communication (if applicable)

Professional Affiliations

List any professional organizations or memberships (e.g., APhA, ASHP, OPA).

Availability & Scheduling

Indicate specific days and times available to work (morning, afternoon, evening) for each day of the week (Monday through Sunday).

References

Provide two professional references with name, relationship, and contact information.

Motivation

Briefly describe your motivation for joining Unity Urgent Care & Pharmacy and how your experience aligns with their mission of patient-centered care.