Refill Requests




			906 South Monroe Street Spokane, WA 99204

Please enter your refill information below. Please allow 24 hours for your refill request.


	*First Name


	MI


	*Last Name

*Address


	*City


	ST


	Zip


	*Sex


	Male


	Female


	*Birthdate


	*Telephone


	*Email




		Enter Prescription Number(s) Below


	*Rx #1


	Rx #2


	Rx #3


	Rx #4


	Rx #5


	Rx #6




	*Please Choose One of the Following:


	Pick Up


	Delivery


	Mail


	Comments/ Special Requests






Please allow 24 hours for your prescription to be refilled. Also, if your prescription does not have refills, we will need to call your physician for reauthorization. It may take 48 hours for the doctor's office to respond to the refill request. Be sure to place your order far enough in advance to allow for these situations.

*Indicates Required Field


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