"Greene County’s Hometown Drugstores"
Xenia
100 N. Detroit St.
(937)374-0899
Fairborn
77 S. Central Ave.
(937)482-0328
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Diabetes Club
Attention Diabetics
Free Video Rental
Preferred Pricing
Preferred Senior Services
Additional Services
Offerred At IHS
Printable Version
IHS Pharmacy wants to make it easy for you to transfer a prescription
from another pharmacy. Simply fill out the form below and we’ll do the rest.
Transfer Prescriptions
Patient Name:
Date of Birth:
Phone:
Pharmacy prescription was last filled at:
Pharmacy telephone number:
Prescription refill number 1:
Name of medication:
Prescription refill number 2:
Name of medication:
Prescription refill number 3:
Name of medication:
Prescription refill number 4:
Name of medication:
Prescription refill number 5:
Name of medication:
Prescription refill number 6:
Name of medication:
Prescription refill number 7:
Name of medication:
Prescription refill number 8:
Name of medication:
