Palmetto Health Pharmacy
 
1) Pharmacy Information
Select the pharmacy name that this refill is on file with.
Pharmacy: 
 
2) Prescription Information
Enter the prescription number(s) and the last name on the prescription. If you have more than one prescription with different last names, select fill prescriptions for multiple people below. Be sure to enter name exactly as it appears on prescription label.

  Patient's Last Name
  Prescription Number
1 4
2 5
3 6
 
3) Delivery Method



 

4) Phone Number

Enter a phone number,including area code, so our pharmacist can contact you if there is a problem with this order. Example:xxx-xxx-xxxx
Phone Number: