Northeast Columbia's neighborhood retail and compounding pharmacy

Order your prescriptions or initiate a transfer online

To order a prescription or initiate a transfer, please use the appropriate form below. If you have any questions or if you need additional assistance, contact us.

Prescription Form

Name

First Name

Last Name

Phone Number

(###)

###

####

Email Address

Rx Number(s)

Transfer Form

Name

First Name

Last Name

Date of Birth

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Information about the pharmacy you're transferring from

Name of Current Pharmacy

Phone Number of Current Pharmacy

(###)

###

####

Desired Prescriptions to Transfer

Order your prescriptions or initiate a transfer online

Prescription Form

Transfer Form

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