Prescription Request Form

Instructions:

Option 1: E-Prescribing:

To E-Prescribe to FedRx via SureScripts or other e-prescribing platforms, submit to NCPDP number 1498422 under FedRx Pharmacy, and select “Retail” option for pharmacy type.

Option 2: Fax & Mail

Fax and Mail option

Step 1: Make sure all prescriptions are dated and signed by the authorizing medical provider.

Step 2: Fax ALL prescriptions and a patient information form to 877-545-5001.

Step 3: Determine if any of the medications are Schedule II Controlled Medications. If you are not prescribing any, nothing further is needed. If you are prescribing any, mail ALL of the original prescriptions and a patient information form to the following address:

FedRx Pharmacy

2731 W Division St, STE A

Chicago, IL

60622

Requesting Refills on Your Prescriptions

You can request refills of your prescriptions simply by sending us a message here and we will be in contact with you right away. You can reach us toll-free at 833-545-5001 too if you want to speak with a member of the pharmacy staff.

Transferring Existing Prescriptions

If your prescriptions were sent to a different pharmacy and you would like to avoid the out-of-pocket costs, trips to the pharmacy, and long waits in inconvenient lines, you can have them transferred to FedRx. Simply give us a call (toll-free 833-545-5001) or send us a message here and include the following information: which pharmacy currently has your prescriptions (include address or phone number if possible), list of medications you want to transfer, name of prescriber and their contact info. We will notify you once the transfer has been completed.

Please contact us if you would like pre-paid express envelopes sent to you for current or future prescriptions.