Prescription Refill

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Online Pharmacy Refill Submission Form
Please use this form for requesting refills for general hospital prescriptions. Please call 612-625-4602 for all questions related to payment. 
** Please Allow 3 Business Days for Orders to be Filled. Please phone ahead to ensure your order will be ready.

Prescription 1
* To submit more than 3 Prescription Requests, please add them to the Comments field.
Prescription 2
Prescription 3
Contact Method
(ie: pick-up time, quantity desired, mailout, etc)