Transfer a Prescription to IHS Pharmacy and Wellness Center

IHS Pharmacy wants to make it easy for you to transfer a prescription from another pharmacy. Simply fill out the form below to tell us about yourself and your prescription, then click on the Submit button to send us your transfer request. Remember, you can always call to have your prescription transferred to our pharmacy, or you can print out the transfer form and fax it to us.

Transfer A Prescription To IHS Pharmacy

Bold* fields are required. We never sell or supply your information to any third parties.
Store Location *	Select Xenia Fairborn Jamestown Home Delivery
Patient First Name *
Patient Last Name *
Patient Phone *
Patient Date Of Birth *	(i.e. 1/23/1969)
Patient Email
Pharmacy Prescription Was Last Filled At *
Previous Pharmacy Phone *
Prescriptoin Refill #1 *
Name Of Medication #1 *
Prescription Refill #2
Name Of Medication #2
Additional Instructions
Enter Code (this helps prevent SPAM) *

IHS Pharmacy & Wellness Centers : Xenia Pharmacy (937) 374-0899 : Fairborn Pharmacy (937) 482-0328 : Jamestown Pharmacy (937) 675-6500