Prescription Refill

Free delivery within Baxter Springs, Lowell, Riverton and within five miles of the store. If you request delivery, you must include your address. Deliveries will be made to indicated address. Include any special directions in the comment box below. Expired refill authorization or refills that require a Doctor's authorization require 48 hour notice and may require Physician's visit. Orders received after 1 P.M. will be delivered the next business day.

Thank you.

Method of Pickup
Pickup Delivery

Contact Information
Name
Address
City	State	Zip
Phone	E-mail

Prescription Numbers
Refill #1	Refill #6
Refill #2	Refill #7
Refill #3	Refill #8
Refill #4	Refill #9
Refill #5	Refill #10

Comments or Request


	Prescription Refill