Gilmer Drug Co
112 Davis Street
Gilmer, TX, 75644
Tel.: (903) 843-5631
Fax.: (903) 843-5603
Request a refill for your medication(s)
Please note that this form allows you to submit up to 5 prescriptions for refill. If you would like to submit more than 5 prescriptions for refill, please complete additional submission forms.


Rx Number(s)

Numbers only
NO letters or dashes