Request a Refill

You can now submit refills over the internet! Just fill in the form to the right and click submit! The two items needed are off your label on your bottle.
  • Prescription Number (R999999)
  • Your First Name (Your Name)
Example Label.
Please completely fill out the form below!

Make sure to type your First Name and RX Numbers exactly as they appear on your prescription bottles.

First Name
Mailed or Pick-up? Mailed Pick-Up
RX Number(s)