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Refill Your Prescription

Pls fill out the information fields below and click on the red "REFILL Prescriptions" button. HealthSource Pharmacy will be in touch shortly. Required fields indicated by *.

first name *

last name *

daytime phone *

email address *
address *

Rx number 1 *

Rx number 2

Rx number 3

Rx number 4

special requests

delivery/pick up method *

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verification image, type it in the box

Personal Information
HealthSource Pharmacy provides this notice to explain its practices regarding collection and use of personal information through this website (the "Site"). We will not disclose, sell, or rent any of your identifiable personal information to any third party, unless approved by you, or required by law. HealthSource Pharmacy may offer you access to certain information by e-mail, and may distribute your e-mail address and name to external service providers who would manage this process for us. These service providers have agreed not to sell or distribute your information to any other party. Instructions to unsubscribe will be included in each e-mail message. Health Source Pharmacy may share non-personal, anonymous, summary or aggregate user data with certain affiliates and other third parties. Please note that, although HealthSource Pharmacy aims to protect your personal information against unauthorized disclosure, the firm cannot guarantee that your personal information will never be disclosed in a manner inconsistent with this policy.

HealthSource Pharmacy uses a variety of security measures to protect your personal information from unauthorized access, use, or disclosure, including the use of Secure Socket Layer (SSL) encryption, when it transmits your personal information over the Internet.

If you have any questions or comments about our privacy policy, please feel free to contact us at 212-481-6600.