Want To Transfer Your Prescriptions To Us?
Transfering your prescriptions to your local Payless Pharmacy is easy! Make one call to us or fill out the form below, and we will do the rest.

* = Required Information
Which pharmacy location fills your prescriptions? *
Pick Up Date - Time *
Not Set
Pick UpDelivery
Delivery Address *
City *
Zip Code *
Step 1: Pharmacy Information
Pharmacy Name *
Pharmacy Phone *
(Find this at the top of the label on the bottle or box).
Your Name *
Your Phone *
D.O.B. *
Your Email *
Step 2: Prescription Information
Prescription #1 *
(To find this, look at the label on the bottle or box. The Rx number is printed directly above your name).
Prescription #2
Prescription #3
Prescription #4
Prescription #5
Special Instructions
Security Code *
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