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PLACE AN ORDER FOR REFILL

PRESCRIPTION REFILLS:
ONLINE REFILL ORDER FORM

FOR FASTEST SERVICE VERIFY AVAILABLE REFILLS AND CALL US TOLL FREE AT
1-866-744-0621

MAIL:
Download the AmeriPharm Acrobat Order Form PDF file and complete refill and payment section of the AmeriPharm order form and mail to us at:

PO Box 5736
Sioux Falls, SD 57117-5736

CUSTOMER SERVICE:
We value you as a customer and work hard to measure up to the quality of customer care that we expect and you deserve.

Call us Toll-free:
1-866-744-0621

AUTOMATED VOICE RESPONSE:
An AmeriPharm Customer Service Associate will respond to your inquiries within one business day. Messages can be left at
1-866-744-0621 24-hours-a-day for:

  • Refills
  • Order status
  • Pharmacy assistance
  • General questions

REFILL REMINDER SERVICE
We provide a friendly reminder about refills. The Refill Reminder Service provides a refill date on the prescription label and on your receipt. Call customer service at
1-866-744-0621.

ONLINE REFILL ORDER FORM
All fields in RED are required.

Your Name :
Patient Name :
Refill # :
Refill # :
Refill # :
Refill # :
Refill # :
Refill # :
Refill # :
Refill # :
Phone # :
Zip Code :
E-mail :
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Comments :
 

 

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