Good Samaritan Pharmacy & Health Services, Inc.

2502 Tamiami Trail N, Nokomis, FL 34275


Ready to apply?

You must meet qualifications and submit a completed application and documents before medication or medical services can be given.


  1. Call 941-445-5687 to be pre-screened and to pick up an application.
  2. Download and print the application using the download links.
  3. Patients of SMH Newtown Clinic can apply in Newtown.  Contact Luldes Serrano: 941-445-5687 or

When your application is completed, call 941-445-5687 for an appointment to come in to finalize your registration. 

Be sure to bring the following items with you when you finalize your registration.

  • Your photo ID.
  • Copy of your latest tax return.
  • Copies of your proof of income for the last 4 weeks in the form of pay stubs, social security, or unemployment statements for every member of your household.
  • Prescription bottles or valid written prescriptions.

Download your forms

When you are finished with the paperwork, give us a call.