Transfer Rx - Post Haste Pharmacy

Refill Request

Transfer Prescription

Rx Transfer Request

Fill out the form below to initiate an Rx transfer.
Looking to refill your prescription? Select “Refill Request” above.

"*" indicates required fields

Patient Details

Name*

First Middle Last

Phone*

Date Of Birth*

Rx Details

We'll use the information you provide here to contact your current pharmacy and transfer your prescription(s) to Post Haste Pharmacy. Please use one form per pharmacy you wish to transfer from.

Current Pharmacy*

Current Pharmacy Phone Number*

Drug Name*

Prescription Details*

Drug Name or RX Number

Please enter either the name of the drug or RX number of the drug you would like to transfer to Post Haste Pharmacy. (Please note: Only one is required but both may be entered)

Want to fill prescription(s) now?*

Yes, Fill as soon as possible

No, File this prescription

Insurance Information

Save time at the pharmacy by providing insurance now

Would you like to provide insurance information?*

Yes

No, Skip for now

Insurance Name*

Member ID*

Please enter your insurance member ID. This number is usually is located on the front or back of your insurance card.

Group Number*

Please enter your insurance plan's group number. This number is usually is located on the front or back of your insurance card.

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