Refill Prescriptions | Hubbard City Drug

This service is for REFILLS.

For new prescriptions you can either bring us the prescription or have your doctor contact us. Feel free to contact us with any questions about new prescriptions, transfers or refills.

You will be asked a few questions about your prescription, then you can quickly place your order over our secure system. Any information submitted is kept strictly confidential.

(1) Who is this Prescription for?
Name*
First Last
E-Mail Address*
Date of Birth*
(2) Which prescriptions would you like refilled?

Please enter your Hubbard City Drug RX refill number(s).
RX Refill No. or Medication Name*
RX Refill No. or Medication Name
RX Refill No. or Medication Name
RX Refill No. or Medication Name
(3) Verify Insurance Information.
Has your insurance information changed since your last refill?*
- My insurance information is current and has not changed since my last refill.
- I need to update my insurance.
Note: you only need to fill this out if your insurance information has changed since your last refill.
Cardholder's Name*
Group Number*
Insurance Company*
Cardholder ID#*
Bin#
PCN#
Relationship to cardholder
(4) SPECIAL INSTRUCTIONS AND NOTES
Comments
(5) Verify information and submit your order.

By clicking on "Submit Refill" you confirm that you are the patient named, or the authorized caregiver for that patient. You further confirm that all the information you are submitting is correct.

To ensure the accuracy of your order we may contact you with questions concerning this refill request.

Please click the "Submit Refill" button and your refill request will be sent.
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