PH: (800) 340-7452 | (360) 568-1297 | FX: (360) 243-3167
Mon-Fri: 9am-6pm
Saturday: 9am-2pm
Sunday: Closed
Holidays: Closed

Prescription Refill Request

Use this handy form to submit up to five prescription refills at a time. Choose whether you want us to notify you via phone or email and our staff will notify you when your pickup is ready.

Last Name:
Phone:
Email:
Prescriptions: Rx #1:   Rx #2:   Rx #3:
  Rx #4:   Rx #5:
Pickup date/time:
Comments: