Transfer RX

Transfer RX Form

Please use the form below to transfer your prescription to Fort Lincoln Pharmacy.
  • Patient Details

  • Prescriptions To Be Transferred

  • If you would like to transfer all prescriptions, simply check yes above. If you would like to selectively transfer your prescriptions, simply start typing to find your medication.
  • List specific prescriptions to be transferred

  • Medication Name
  • Prescription number from current pharmacy
  • Medication Name
  • Prescription number from current pharmacy
  • Medication Name
  • Prescription number from current pharmacy
  • Medication Name
  • Prescription number from current pharmacy
  • Medication Name
  • Prescription number from current pharmacy
  • Medication Name
  • Prescription number from current pharmacy
  • This field is for validation purposes and should be left unchanged.