UHP Refill Your Prescription

Refill Your Prescription
Please choose a Pharmacy location.*
Prescription Number or RX No ( You can find this information on the current vial or medication package or bottle.) For multiple RX numbers, please enter with a comma.
Patient Name

First NameLast Name
Patient Phone Number
Optionally You can upload an image of your existing prescription label here:

Please note that original prescription must be presented before the pharmacist complete the prescription.
Cancelof
Additional Information
Should be Empty: