Mail Order Refills

Your needs are important to us and we appreciate your patronage. Should you require any assistance, please contact us at (800) 662-0586 or via email at This email address is being protected from spambots. You need JavaScript enabled to view it.

To refill prescription(s) online, simply complete the form below and click the Submit Order button.

PharmacyCare Refills Indicates required field.

Patient Information

Card ID:Ship Via:
First Name:RequiredLast Name:Required
Email Address:RequiredPhone:
Date of Birth:Required

Prescription Information

Prescription #1:
Prescription #2
Prescription #3
Prescription #4
Prescription #5
Prescription #6
Prescription #7
Prescription #8
Prescription #9
Prescription #10
Prescription #11
Prescription #12
Prescription Label
Please verify email address: Required

Featured Items

URAC Certification URAC Certification

PHARMACY BENEFIT MANAGEMENT
EXPIRES 01/01/2018
PBM Services Provided by ProCare PBM

MAIL SERVICE PHARMACY
EXPIRES 04/04/2018
Mail Order Provided by ProCare PharmacyCare