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Transfer Your Prescription

Transfer Your Prescription

Existing Pharmacy Information

Please enter the information for the pharmacy you are transferring from.

Please enter the prescriptions you would like to transfer to Health Gate Pharmacy.

Only 10 Rx numbers can be submitted per request
Rx Numbers

Personal Information

Who are the prescriptions for?
MM slash DD slash YYYY
Do NOT include any personal health or billing/credit card information.
Terms and conditions(Required)