Medication Refill Request

Please reach out to your Pharmacy first.
If you have already reached out to your Pharmacy, fill out the form below.
Please allow 48 hours for your request to be answered.

Information Needed

Medication Refill Request
Controlled Substance *
Please allow 3 - 5 business days for us to process your request if an authorization IS NOT required, otherwise it could take up to a maximum of 14 days.
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