* = Required Information
Who is this prescription for?
Last Name *
First Name *
Phone Number *
Location	Please select.25 Collins Rd, Bristol57 South St, Bristol25 Mellen St, BristolEast HavenNew BritainSouthingtonWinsted
RX REFILL NUMBERS
1 * 2 3 4 5
ADD MORE PRESCRIPTIONS OVER THE COUNTER ITEM
Name Qty 1 2 3 4 5
PICK UP OR DELIVERY? PickupDelivery
Would you like us to notify you when your prescription(s) are ready? Please select.No, thanksYes, via phone