RX4U Refill

  1) Pharmacy Information Select the pharmacy name that this refill is on file with. Pharmacy:  IH RX4U TH RX4U   2) Prescription Information

Enter the prescription number and the last name on the prescription. Be sure to enter name exactly as it appears on prescription label.

Express Refill
  Patient’s Last Name: *Required
  Prescription Number: *Required

3) Phone Number

Enter a phone number,including area code, so our pharmacist can contact you if there is a problem with this order or additional information is needed from you. Phone Number:  e.g: 251-5551212*Required Invaild Phone Number  
Would you like to:
Pickup your prescription
Have your prescription mailed to your residence
Have your prescription delivered
Yes No

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