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Transfer Prescriptions

Contact Information

Providing contact information will allow us to contact you if we have any questions about your transfer request.

*First Name	*Last Name
*Phone (Example: 123-456-7890)	*E-mail Address

Patient Information

Same as Contact Information

*First Name	*Last Name
*Phone (Example: 123-456-7890)	*E-mail Address
*Gender	*Date of Birth
*Street Address	*City
*State	*Zipcode

Prescription Information

Enter prescription information as it appears on the prescription label.

*Pharmacy Name
*Pharmacy Phone (Example: 123-456-7890)	*Prescription Number
*Prescribing Doctor's Name	*Doctor's Phone (Example: 123-456-7890)
*Drug Name	Drug Strength (Optional)
Delete This Prescription

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Insurance Information

Enter prescription insurance coverage information as it appears on your card.

*Name of Insurance
*First Name	*Last Name
*Member ID	*Group Number
*BIN Number	*PCN Number

Delivery Method

How would you like to have your prescription prepared.

Choose Method
Pick Up Delivery Shipping We will contact you at this number as soon as your prescription is ready to be picked up. Phone OR we will be contacting you at this number for a form a payment before we send your prescription order out to the address you have provided below.
Shipping Information
Please Check if the shipping address is the same as the Patient address.
*Street Address	*City
*State	*Zipcode
Shipping Preferences
Please choose the shipping option that you prefer below. (NOTE: hazardous agents your prescription order out to the address you have provided below. US Postal (Pritory Mail) FedEx All delivery and shipping charges and fees are applicable. Please allow 24-48 hours for us to transfer, process, and deliver your prescription. Welcome to the Central Drugs Family!!

Patient Privacy: We understand that your medical information is personal. We are committed to protecting your medical information. From more information read out Pharmacy Privacy Notice

Questions, comments or concern about this process? Please Contact Us

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Order Prescriptions

Doctors

Patients

Help

Transfer Prescriptions