Medicine Shoppe #0427
701 Bridge Street
New Cumberland, PA, 17070
Tel.: (717) 774-6262
Fax.: (717) 774-8852
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