RX Refill - Home Delivery Only Form

Our online service lets you refill any valid prescription currently on file at your DOH Central Pharmacy. It's quick and easy; all you need is your DOH Pharmacy prescription numbers and an Internet connection. Order refills any time of the day or night, from work or home. You don't even have to enter a password. Your request is transmitted directly to our Central Pharmacy and your refill will be mailed directly to the address on file. If you do not wish the Rx to be sent to the address on file, please contact your County Health Department prescriber. Thank you.

Enter Prescription Number
Where can I find my prescription number?

You can find your prescription number on your refill slip or prescription bottle. Remember to enter all 8 digits listed as shown in the highlighted box below. Do not enter any spaces or dashes between the 8 digits you enter, regardless of whether a space or a dash appears on your refill slip or bottle.

Please click on the images for a larger view.

The refill slip and prescription label displayed are samples only.

Your refill slip and prescription label may vary by design.

Enter a phone number so our pharmacist can contact you if there is a problem with this order.