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Please note that our new website / web portal is more secure.  The safest way for you to request a new Refill Rx Login is in person.  However, if you wish, you can choose to receive your Login by e-mail if you use the form below (using the Rx Lines) and fill in your:

  • Home Telephone Number
  • Social Security Number
  • Date of Birth (in specified field)
  • E-mail Address
  • Rx number and drug name for at least one of your prescriptions

All of the above information must be provided or we will not be able to generate a login ID.


We check prescription refill requests once daily.  Therefore, please allow 24 hours for your prescriptions to be filled.  If you do not have refills remaining, physician's offices will often require up to 3 days notice to return our refill requests. 

You can check the status of your refill request by calling 697-6125 or by visiting your presription profile on your web portal.

Prescription Refills

 

Patient Name:
Person Typing Form
Patient's Date of Birth:
E-mail Address:
Telephone Number:
Rx Number/Drug Name 1:
Rx Number/Drug Name 2:
Rx Number/Drug Name 3:
Rx Number/Drug Name 4:
Rx Number/Drug Name 5:
Rx Number/Drug Name 6:
Rx Number/Drug Name 7:
Rx Number/Drug Name 8:
Rx Number/Drug Name 9:
After you submit your
request you will return
to our home page.
Thank you for using our
online refill request form!		 Your request is sent by e-mail to rx@howardsdrug.com


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