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Select the corresponding number, as represented below, for descriptions of available page features.
Prescription Refill Form Page Pharmacy # Prescription Number Patient's Last Name Copy Name From Above Pick-up Time
1
Pharmacy Number — This is the number of the pharmacy where you had the prescription filled and is located on the upper left corner of the label. Please enter this number where indicated on the order refill page.
2
Prescription Number — This is the prescription number, located on the left side of the label. This number associates this prescription to you in our records by your last name. Please enter this number where indicated on the order refill page.
3
Patient's Last Name — We ask for your last name as a security measure to ensure that patients receive the correct medications.
4
Copy Name From Above — If you're ordering more than one refill with the same last name, just click copy name from above and we'll fill in the name for you on the other prescriptions.
5
Pick-up Time — Select the time you'd like to pick up your prescription. You can choose from several times, from tomorrow morning to two days from now. If a prescription requires more time, we will let you know.
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