Transfer Prescriptions

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Pharmacy Icon Previous Pharmacy

Pharmacy Transferring From


Pharmacy Phone


Patient Icon Patient Information

First Name


Last Name


Contact Phone


Date of Birth (mm/dd/yyyy)


Email Address (optional)
Enter your email to receive an order confirmation. We do not save or store email addresses.
Address Icon Patient Address

Address


Address 2


City


State


Zip


Insurance Icon Insurance Information (optional)

BIN Number


Group Number


ID Number


PCN Number


Prescription Icon Prescriptions (Rx)

Prescription #1 Rx Number


Medicine Name



Prescription #2 Rx Number


Medicine Name



Prescription #3 Rx Number


Medicine Name



Prescription #4 Rx Number


Medicine Name



Prescription #5 Rx Number


Medicine Name



Prescription #6 Rx Number


Medicine Name



Prescription #7 Rx Number


Medicine Name



Prescription #8 Rx Number


Medicine Name



Prescription #9 Rx Number


Medicine Name



Prescription #10 Rx Number


Medicine Name


Pickup Options Icon Pickup Options

Please select pickup method for your prescription.
Pickup Icon
Pickup
Mail Out Icon
Mail
Delivery Icon
Delivery







Address


Address 2


City


State


Zip



Online Ordering Restrictions

Pickup:
Orders placed before 7:00PM (Mon-Fri) or 3:00PM (Sun) will available for pickup within an hour. All orders placed after the cutoff time will be available the following business day after 9:00AM (Mon-Sat) or 1:00 (Sun).

Mailout:
Orders placed before 3:00PM (Mon-Fri) will be mailed out the same day. All orders placed after the cutoff time will be dropped off at the Post Office the following business day. The Post Office delivers most prescriptions in 2-5 days.

Delivery (Columbus):
Delivery within Columbus city limits ONLY.

Orders placed before 5:00PM (Mon-Sat) will be delivered the same day. All orders placed after the cutoff time will be delivered the following business day (Mon-Sat).

No Deliveries on Sunday's.


Delivery (Genoa/Monroe):
Delivery within Genoa/Monroe city limits ONLY.

Orders placed before 3:00PM (Mon-Sat) will be delivered the same day. All orders placed after the cutoff time will be delivered the following business day (Mon-Sat).

No Deliveries on Sunday's.


Pencil Icon Notes for Pharmacy (optional)



Shopping Cart Time Saver - Additional Products (optional)



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