top of page

rx management random.png

HOME
ABOUT
OUR TEAMS
JOBS & CAREERS
SERVICES
CONTACT
COMPOUNDS
MORE

Use tab to navigate through the menu items.

Refill Request

Clay Discount Pharmacy

First Name

Email Address

Last Name

Date of Birth * required

Are you a patient of Clay Discount Pharmacy? * Required

Yes

No

Are you requesting all medications be filled (including medicaiton refills) or just specific medications? If you have new prescriptions please let us know!

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

I accept terms & conditions

Thanks for submitting!

Untitled design-5.png

SCRUB WORLD.png

bottom of page