Medicine Shoppe #0645
125 Pillow Street
Butler, PA, 16001
Tel.: (724) 282-8446
Fax.: (724) 282-1113
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