NCR Pharmacy Online Prescription Activation Form

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.