Transfer Your Prescription to ConnectRx

Simply fill out the form below. A pharmacist will call you back to gather all the details of your prescription transfer.

"*" indicates required fields

Name*

First Name Last Name

Email Address*

Address*

Street Address City ZIP Code

Sync

Yes, sync all my meds to the same refill schedule

Member

Yes, I'm a CDPHP member

Options

I'd like a 90-day supply, if available

I'd like a no-cost, in-person medication review at ConnectRx

Current Pharmacy Name*

Current Pharmacy Phone*

A pharmacy team member will contact you within 24-48 hours during regular weekday pharmacy hours. Please be prepared with your medication list.

Preferred Contact Method*

Phone Call

Text Message

Daytime Phone*

Preferred Weekday Call Time*

Morning

Afternoon

Name

This field is for validation purposes and should be left unchanged.

Thank you!

Thanks for requesting a prescription transfer to ConnectRx. A pharmacist will call you to begin the transfer process. We look forward to serving you!

– The Team at ConnectRx