Rx Refill

Refills Made Easy
We’ve made it easy for you to refill your prescriptions on-line on this page, via e-mail (plainsbororx@aol.com), by phone, or just ask to be an automatic refill customer!

 

Who is this prescription for?

First Name*:

Last Name*:

Street*:

City*:

State*:

Zip*:

Email*:

Phone Number *:

RX Refill Number & Drug Name:

1.

2.

3.

4.

5.

ADD MORE PRESCRIPTIONS [OR]
OVER THE COUNTER ITEM(S):

Name Quantity
1

2

3

4

5



PICK UP OR DELIVERY?  Pick Up Delivery
Would you like us to notify you when your prescription(s) are ready?

Doctors Name:

Doctors Phone:

Security Code *: captcha

Protecting patients’ privacy and securing their health information is a core requirement of our pharmacy