Request Prescription Transfer

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

PRESCRIPTION(S)

To request a transfer (or fill) multiple prescriptions, start by typing the first 2-3 letters of your medication and then select from the drop-down. Successive drop-downs will be displayed. For each medication add the dosage amount with its unit of measurement (e.g., 5 mg)

Medication Name*

Dosage*

Medication Name

Dosage

Medication Name

Dosage

TRANSFERRING PHARMACY

Your Pharmacy's Name*

City/State*

City State

Phone*

YOUR DOCTOR

Prescriber's Full Name*

Phone*

CONTACT INFO AND CONSENT

Your Name*

First Last

Email*

Phone*

Date of Birth*

I authorize BioPlus to contact the transferring pharmacy, prescriber, and myself.*

Yes

Exciting News! Kroger Specialty Pharmacy is now BioPlus Specialty Pharmacy. Learn more here.

ALERTS

Request Prescription Transfer

PRESCRIPTION(S)

TRANSFERRING PHARMACY

YOUR DOCTOR

CONTACT INFO AND CONSENT