PGPA Pharmacy - 3544 Meridian Crossing Dr., Suite 120, Okemos, MI 517.381.7472

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SECURITY AND PRIVACY INFORMATION - PLEASE READ BEFORE SUBMITTING A REFILL REQUEST

PGPA Pharmacy values your relationship with us, and we know that respect for your privacy is the foundation of that relationship.  We are committed to protecting the privacy of your protected health information (PHI) that is in our possession, and only using and disclosing your PHI as necessary to providing you with health care products and services.  All information submitted in the online refill form will be treated as a confidential part of your medical record.

While PGPA Pharmacy utilizes encryption technology on this website, no data transmission over the internet can be considered 100% secure.  When sending refill information over the internet, you agree that PGPA Pharmacy can not be held liable for disclosures of your information due to system errors or unauthorized acts of a third party.



Please use this form to order your prescription refills.  Forms received after 4:00 pm will be ready the next business day.  
Last Name
Date Of Birth
1st Refill Number (From Label On Bottle)
2nd Refill Number
3rd Refill Number
4th Refill Number
5th Refill Number
Picking up today? Yes or No
Comments
©2008 PGPA Pharmacy. All rights reserved.
3544 Meridian Crossing Dr. Suite 120, Okemos, MI 48864
Phone: (517) 381-7472
Fax: (517) 381-8724
Email: myrx@pgpapharmacy.com