Stellus Rx - Transfer Request

Stellus Rx - Transfer Request

Thank you for choosing Stellus Rx, a pharmacy that provides trusted, pharmacist-led health support in every moment that matters. Please provide the following information to get started with your new personalized pharmacy.

Name
N/A

Required First Required Last
Date of Birth *
N/A

Please enter in the following format: MMDDYYYY
Phone Number *
N/A

Please enter as follows: xxxxxxxxxx
Address
N/A

Required
Street Address
Address Line 2 Required City Required State/Region/Province Required
Postal / Zip Code

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Country
Who is your current primary care provider? Please list the physician and practice name.
N/A
Please list any drug allergies you have below.
N/A
Are you interested in monthly check-ins with our clinical pharmacy team and synchronized monthly refills?
N/A

You may also choose to use our convenience packaging to no longer need bottles for your medications.
Pharmacy Insurance Information
N/A

Member ID
Rx BIN Rx Group Rx PCN

Please bring your insurance card to the pharmacy if you have any questions about the information requested below.
Current Pharmacy Information
N/A

Pharmacy Name
Phone Number

Please provide your current pharmacy information to begin the transfer process
Add medications here...
Please list the medications you'd like to have transferred. *
N/A

Please list in the following format (i.e. Metformin 500mg)

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