You can refill your prescriptions easily by completing the form below! We have allowed for 10 prescriptions on one form to be refilled. Should you need to refill more prescriptions, please complete the form as many times as necessary. If you do not have "Rx Number" for a refill please at a minimum place the name of the prescription in the form.
You can use the "OTC and other Purchases" line on the form for any non prescription merchandise you would like to have delivered at the time of your refill delivery.
Should be be refilling a prescription for a dependent, please complete with their name on the form.