Order Medication (Cost Plus)

Hey there!

Thanks for choosing Curtis Pharmacy Cost Plus - we look forward to meeting you and helping you save on your healthcare!
What is your name?*

First NameLast Name
Email*
example@example.com
Privacy Policy*

I have READ and AGREE to the privacy policy at: https://curtispharmacy.com/privacy-policy
Welcome to Curtis Pharmacy!

We're excited to help you ditch insurance and save more on your medications. In order to move your prescriptions to Curtis Pharmacy, we need to know a bit more about you and your medications.
Which Curtis Pharmacy location would you like your prescriptions at?*

305 Main St., Claysville, PA 15323575 Henderson Ave., Washington, PA 15301802 Vanderbilt Rd., Connellsville, PA 15425555 PA-88 Carmichaels, PA 15320
Date of Birth*

MonthDayYear
Date
Biological Sex*

FemaleMale
Mobile phone number*
Address*

Street Address

Street Address Line 2

City

Zip Code
State*
What medications, herbs, vitamins, or supplements are you currently taking?*
Please list any current medical conditions you have. (e.g. high blood pressure, diabetes)
Do you have any allergies?*

Yes, I have allergiesNo known allergies
List all of your allergies to food, medication, dyes, supplements, or anything else.*
Almost there!

In order to confirm and fill your prescriptions, our pharmacists will need a bit more information about your medications.
Medication(s) to be transferred*
Prescriber's Name

First NameLast Name
Prescriber's Phone Number
Please enter a valid phone number.
Previous Pharmacy Name
Previous Pharmacy Phone Number
Please enter a valid phone number.
Would you like to sign up for our membership to get the reduced prescription prices, 10% everything in the store, and 1 free delivery/mailing per month*

Yes, let me choose between the quarterly ($20) and annual ($75) options.No, I want non-member prices
Do you plan to use an HSA or FSA card for your membership?

NoYes
Important Note:

Currently, memberships do not qualify for FSA or HSA spending, but we're hopeful for future changes in this area.

You can still use your FSA/HSA cards for copays, and we'll contact you to confirm the payment method. For membership fees, kindly use an alternative card. Thank you for your understanding, and please feel free to reach out with any questions or concerns you might have.

Membership Options*

Quarterly Membership ($6.67/mo) Product Image

Quarterly Membership ($6.67/mo)For $6.67 a month (billed quarterly), get-Reduced prescription drug prices-10% off all OTCs, herbal supplements, and storefront items-1 Free monthly delivery/shipping

$20.00 for each three months

Annual Membership ($6.25/mo) Product Image

Annual Membership ($6.25/mo)For $6.25 a month (billed annually), get-Reduced prescription drug prices-10% off all OTCs, herbal supplements, and storefront items-1 Free monthly delivery/shipping

$75.00 for each year

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Hey there!

Welcome to Curtis Pharmacy!

Almost there!