Transferring your prescriptions to Online Pharmacy is simple.
Fill out the form below and we'll do the rest!

We will send you a confirmation email when your transfer is complete.

First Name:
Last Name:
Date of Birth:
Street Address:
City:
State:
Zip:
Phone Number:
E-Mail Address:
Comments:

Would you like to be contacted by phone regarding your prescriptions? Yes No Please enter the pharmacy information that we will be transferring from below:
Pharmacy Name:
Pharmacy Phone:

Prescription Name:
Prescription Number:

Prescription Name:
Prescription Number:

Prescription Name:
Prescription Number:

Prescription Name:
Prescription Number:

Drive-thru Online Pharmacy

210 South Main Street, Suite 100
P.O. Box 236

Brownsville, KY 42210

Phone: 270-597-1044
Fax: 270-597-1045