Transfer a Prescription

Fill out the form below and we'll take care of the rest. We'll contact your old pharmacy and handle the transfer for you.

Prefer to call? (385) 275-7436

Your Information

We'll use this to verify your identity with your old pharmacy.

First Name *

Last Name *

Your Phone Number *

Date of Birth *

Format: MM/DD/YYYY (e.g. 04/15/1952)

Tell us where your prescriptions are now.

Pharmacy Name *

Pharmacy Phone Number *

List the medications you'd like us to transfer, or choose to transfer all.

Transfer all of my medications

Check this if you want to move every prescription you have.

Or list specific medications:

Notes for Our Pharmacy (Optional)

Anything else you'd like us to know? You can also verify your insurance in person.

Your Message (Optional)

0 / 256 characters

Need help filling this out? Call us at (385) 275-7436