Patient Transfer – H&W Drug Store

Transfer a Prescription

Tell us about yourself so that we can verify who you are with your old pharmacy

First Name

Last Name

Phone Number

Birthday

New Pharmacy Location
Select which of our locations you'd like to use

New Pharmacy Location Select which of our locations you'd like to use

Previous Pharmacy Info
Tell us about your old pharmacy so we can transfer your medications

Pharmacy Name

Pharmacy Number

Prescriptions
Add the medication name and Rx number for all that you'd like to transfer

Prescriptions

Transfer

Transfer all of my medications

Notes for Pharmacy (Optional)
Verify your insurance here or in the pharmacy when you get your medication

Questions or Comments

Agreement

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