Transfer Your Prescriptions

If you would like our pharmacists to contact your local pharmacy to transfer a refillable prescription for pick-up, please complete the following information. Allow one business day for your prescription to be processed for pick-up. If your medications are needed in less than 24 hours, contact the pharmacy by telephone at 319-384-6800.

Patient Information

First Name

Last Name

Phone

Date of Birth

Allergies

Please list any known allergies to medications.

UI Health Care Pharmacy

Location

Requested Pickup Date and Time

Please allow one business day for your prescription to be processed for pick-up. If your medications are needed in less than 24 hours, please contact the pharmacy by telephone at 319-384-6800.

Current Pharmacy

Name

City

Phone

Enter your pharmacy name, phone number, and prescription (Rx) number for each prescription you are requesting to transfer.

Prescriptions

Add Your Prescriptions Below:

Add Your Prescriptions Below:
Prescription Example: Penicillin 500mg - 3 times daily Fill this prescription now? Yes, fill now No, save for later

If you do not have your prescription number, please type the drug name and strength for each refill you are requesting in the boxes provided below.

Additional Information

Comments

Is there anything we should know before filling your prescriptions?

University of Iowa Health Care pharmacies accept most major insurance plans, but insurance plans may not cover all medications. Please review all prescription insurance claims with pharmacy personnel before you leave the pharmacy.

Transfer Your Prescriptions

Patient and Visitors

Medical Professionals

Employees & Community