Thank you – your form has been successfully submitted. A pharmacy coordinator will follow up with you to go over the following:

  • Review your medication order.
  • Inform you of your insurance coverage, if applicable, and/or your cost of your medication order.
  • Collect shipping and payment information.


For patient safety and as part of our patient identification policy, you will be asked to provide your legal name, date of birth and address submitted at time of registration. Please feel free to ask the pharmacy coordinator who contacts you any questions or concerns you may have, so that we might assist you appropriately.

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