Fairview Pharmacy . Refer a Patient
500 Katie Avenue, Hattiesburg MS 39401
Mon to Fri 9:30am to 6pm · Sat 10am to 1pm · Sun closed
Download the forms
- Download the Fairview Patient Referral Order, PDFForm FV REF 01 . v3 . 07/2026
- Download the Fairview Medication Update Form, PDFForm FV MED 01 . v3 . 07/2026
- Download the Fairview 2025 Medication Adherence Scorecard, PDFForm FV QS 25 . v1 . 08/2026
Request a printed pad
Delivered by hand within two business days. No charge. No patient information on this form.
Request a printed referral pad
Four fields, no patient information. We deliver the pad to your practice by hand.
Typical response: Delivered within 2 business days
E prescribe
NCPDP 2515104NPI 1144383613
Ask for your statin gap list
Diabetic patients of yours who fill with us and have no statin on file. Getting a statin on file is a prescribing decision, and we cannot close it from behind the counter. No charge. Call 601 544 4871 or fax a request on practice letterhead to 601 583 2298. Phone and fax only, no web form, because that list is protected health information.
The Five Patient Pilot
Send five patients you believe are non adherent. At day 90 your office receives a written report on each: fill history, gaps closed, and therapy issues identified. No cost, no commitment, and no obligation to send a sixth. Start by calling 601 544 4871 or faxing five referral forms to 601 583 2298. Phone and fax only, never a web form, because patient names are protected health information.
Coverage
- Same day delivery in Hattiesburg
- Tuesday and Thursday Pine Belt routes: Petal, Purvis, Oak Grove, Sumrall, Laurel, Ellisville, Columbia, Collins, Seminary, and Prentiss
- Clinic delivery for injectables, timed to the appointment
- Discreet, unmarked packaging on request
- Plans: call 601 544 4871 and we will verify any plan in under a minute
Questions
601 544 4871, ask for Dr. Mike. I answer my own phone.