RiverRx

Transfer Your Prescription

To transfer prescriptions or enroll with River Rx, please fill out the requested information below and press 'Send' or simply bring in your prescription bottles from your current pharmacy.

Once you have become our customer, you will be able to order your prescription refills by phone, fax or online.


	Your Information
Your Name:*
Date of Birth:*
Home Phone:*
Work Phone:
	Your Old Pharmacy's Information
Old Pharmacy's Name:*
Phone Number:*
Old Pharmacy's Prescription Number(s):*
	Your Insurance Info
Cardholder's Name:
Insurance ID:
Group:
Bin #:

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Phone: 301-654-MyRx • Fax: 301-654-6977

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Transfer Your Prescription