MICHIGAN
COMMUNITY
PHARMACY
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Transfer Your Prescription
Fill out the form below and we'll handle the rest. We'll contact your previous pharmacy to transfer your prescription.
Patient Information
First Name
*
Last Name
*
Phone Number
*
Date of Birth
*
Previous Pharmacy
Pharmacy Name
*
Pharmacy Phone
*
Additional Information
Notes (Optional)
Submit Transfer Request
Questions? Call us at
(248) 618-3912
