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.