NCR Pharmacy Online Prescription Activation Form


On 01 JAN 2024 this website will be discontinued. Please utilize the following options for your prescription needs:


Thank you for taking advantage of this new process to maximize social distancing and to reduce your wait time at the pharmacy.

Note before beginning:

  • This form is NOT for refills.
    • For refills, call 1-800-377-1723 or use Tricare Online. Refills will be ready in 3-5 business days.
  • If you provide your cell phone number and carrier you will receive a text when your prescriptions are ready for pick-up.
  • Prescriptions activated before 12:00 pm will be ready after 2:00 pm or when notified.
  • Prescriptions activated after 12:00 pm will be ready the next business day after 9:00 am.
  • Prescriptions must be picked up within 14 days.

Please fill out the following information. The ** items are required.

IMPORTANT: Please make sure you choose the correct pick up location.