Auto-Refill Your Prescriptions

Get in touch

914-835-1125

trottasrx@gmail.com

At Trotta's West Street Pharmacy we value your time and realize how busy you are. Sometimes it is hard for you to remember to refill your prescription. Don't worry, just fill out the form below and become part of our Ready Rx Refill Program. We will automatically refill your prescription for you. We can even deliver it directly to your home if you desire. It is that easy. There is no charge to be part of this program. Just another way Grassy Sprain Pharmacy helps you make sure you take your medication on time and get the most benefit from your prescriptions.

Fill out and submit the form below to guarantee you never run out of your prescription again!

Transfer Rx Form

Step 1

Patient Information

First Name

Last Name

Middle Initial

Birthdate

Phone Number

Email Address

Insurance Provider

Step 2

Prescription Information

Prescription Name

Prescription Number

Prescription Name 2

Prescription Number 2

Prescription Name 3

Prescription Number 3

Prescription Name 4

Prescription Number 4

Prescription Name 5

Prescription Number 5

Step 3

Enrollment Confirmation

Opt-In

I am requesting to be enrolled in the Ready Rx Auto-Refill Program. I understand prescriptions are not eligible for the Ready Rx Auto-Refill Program if they: 1) Are controlled substances, 2) Are paid for by Medicare Part B, Worker's Compensation or State Medicaid 3) Or fail to meet all eligible refill requirements.

At Trotta's Pharmacy we value your time and realize how busy you are. Sometimes it is hard for you to remember to refill your prescription. Don't worry, just fill out the form below and become part of our Ready Rx Refill Program. We will automatically refill your prescription for you. We can even deliver it directly to your home if you desire. It is that easy. There is no charge to be part of this program. Just another way Trotta's Pharmacy helps you make sure you take your medication on time and get the most benefit from your prescriptions.

Fill out and submit the form below to guarantee you never run out of your prescription again!