Close

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*
YYYY dash MM dash DD
This field is for validation purposes and should be left unchanged.

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