Send Us Your Refill Request We will get it prepared for you within 1 hour of receiving your email. If we will have any questions or run into any issues we will contact you immediately. Name * Phone Number Email Your Medication Names or RX Numbers: RX # Or Name: RX # Or Name: RX # Or Name: RX # Or Name: RX # Or Name: RX # Or Name: RX # Or Name: RX # Or Name: Would you like a Delivery or to Pick-up? Delivery Pickup Please Enter the Code * Special Instructions. * = Required Information Submit