Medicine Shoppe #0838
20 Bailey Avenue
Mt Washington, PA, 15211
Tel.: (412) 481-2400
Fax.: (412) 481-9310
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.

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Rx Number(s)

Numbers only
NO letters or dashes