TO ENROLL IN OUR MAIL ORDER PHARMACY PROGRAM NOW, CLINK ON THE LINKS BELOW TO PRINT BOTH FORMS. ONCE YOU’VE COMPLETED THE FORMS, MAIL THEM TO US.

Prescription by Mail Order Form: [ English | Spanish ]
Health, Allergy and Medication Questionnaire [ English | Spanish ]

 

Toll Free Phone: 866-448-8040
Toll Free Fax: 866-461-8411

11001 Roosevelt Blvd, Suite 1400
St. Petersburg, FL 33716

 
EmailEmailEmailEmail
Menu Title