Medicine Shoppe #1202
821 Scioto Street
Urbana, OH, 43078
Tel.: (937) 653-3914
Fax.: (937) 653-5894
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