Compound Rx Refill

Who Is This Prescription For?

Name*

First Last

Phone Number*

Email

Medications Needed

Entering Refill Information
Enter your refill Rx# below.

Rx Number 1:

Enter your Rx number from your prescription bottle.

Rx Number 2:

Pick-Up Information

Refill Availability: 1-4 Days
We like to have 48 hrs. notice to prepare your compounded refill before you can pick it up or have it shipped out. Shipping takes 1-3 days depending on our proximity to us. If you need this sooner, please call us to discuss.

Pickup, Delivery or Shipping*

Payment Information

Please call the pharmacy at (570) 784-9582, M-F 9a-5p to make a payment if needed.

Payment Options

Bill my Credit Card on File
I will call the pharmacy to arrange for payment

Would you like us to notify you when your prescriptios are ready?*

No, Thank You
Yes, via Telephone
Yes, via Email
Yes, via Text Message (cell # should be in phone Above)

Message or Instructions To The Pharmacy

Captcha

To start you Compounded Rx Refill, please fill in the form using the Rx number or if you don’t have the number, the medication name for each.

Who Is This Prescription For?

Medications Needed

Pick-Up Information

Payment Information