Donation Requests

Medicine Center & Medicine Shoppe Pharmacy Donation Request Form

In order to be considered for a donation an organization must submit the request form below.

To be considered, all requests must allow a minimum of 2 weeks notice. Information provided on this form will be used to help us evaluate your organization’s request and communicate our donation procedures. The decision to make a donation is at the discretion of Medicine Center & Medicine Shoppe Pharmacies.

Due to the quantity of donation requests we receive, we are unable to fulfill every donation request. You will be contacted by a Medicine Center/Medicine Shoppe Pharmacy representative within 2 weeks if we are able to fulfill your request.

Please note, Medicine Center & Medicine Shoppe Pharmacies will not provide donations to the following:

Individuals seeking aid
Organizations lacking proof of a Federal Tax Identification Number via a W9 form
Conferences or seminars
Research projects
Travel for individuals or groups
Political organization

Type of donation you're seeking (Example: Gift Certificate, Gift Basket, Funds/Sponsorship or Advertisement)*
Organization*
Name
FirstLast
Phone
Email
Address*
Street AddressCityState / Province / RegionZip / Postal Code
Pharmacy that you're requesting this from.
Date of event, if applicable:
Please tell us a bit about your organization.*
To facilitate our processing of your request please supply your Federal ID. (Not required.)
Have further information that might be helpful in explaining your event/organization. Feel free to upload it here. (Example: A flyer or fundraising letter.)

Donation Requests

Medicine Center & Medicine Shoppe Pharmacy Donation Request Form

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