New Rx Request

1052 S. Powerline Rd.

Deerfield Beach, FL 33442

Phone: (800) 899 - 4852

Fax: (877) 823 - 7505

Hours of operation:

Monday 9:30 A.M - 5:30 P.M

Tuesday 9:30 A.M - 5:30 P.M

Wednesday 9:30 A.M - 5:30 P.M

Thursday 9:30 A.M - 5:30 P.M

Friday 9:30 A.M - 5:30 P.M

E-Mail : info@med-care.us

Thank you for helping make Med-Care Pharmacy a better place

NEW PRESCRIPTION REQUEST

In order to begin your prescription request, please choose from a format of your convenience, print and/or fill out the necessary information and submit your request to Med-Care Pharmacy, It’s that easy!

Our trained prescription specialists will review your request and verify with you, any missing or incomplete .

Once your prescription request has been reviewed, we will send your request to your doctor and inform you of when your prescription has been approved as well as of when your supplies will be shipping to your door.

In order to expedite your request, we ask that your please contact your doctor as soon as you submit your application and inform them of your request. Provide them with our information and let them know that you have chosen MED-CARE PHARMACY as your diabetic supplier. This way, your doctor will be able to approve your prescription and provide us with any needed supporting documentation without delay.

TO SUBMIT A REQUEST FOR A PRESCRIPTION (choose one):

1. Fill out the Prescription Request Form below and click submit; or,

2. Download the prescription request, fill it out using adobe Acrobat or print and complete the request by hand

You can send us your request via email to: rxs@med-care.us ;or mail it to:

Med-Care Pharmacy

1052 S. Powerline Rd.

Deerfield Beach, FL 33442

TO SUBMIT A NEW PHYSICIAN'S PRESCRIPTION (choose one):

1. Physicians may fax to (877) 823 - 7505 or email to rxs@med-care.us prescriptions directly
to Med-Care Pharmacy,

2. Patients may mail it original* prescriptions to:

Med-Care Pharmacy

1052 S. Powerline Rd.

Deerfield Beach, FL 33442

* No copies, duplicates or emailed prescriptions will be accepted from patients to prevent multiple submissions.

If you have any questions or would prefer to place your request through the phone,

please call 1 (800) 899 - 4852

Thank you for choosing Med-Care Pharmacy!

Prescription Request Form

Download PDF Request

First Name, Last Name:: Enter Name

Email: Enter Email

Submitting Form...

The server encountered an error.

Form received.

Please include any details about your request Enter Your Message

Phone: Enter Phone Number

Home Address: Enter Address

City: Enter City

State: Enter State

Zip code: Enter Zip

Date of Birth: Enter DOB

Insurance Carrier: Enter Insurance Name

Doctor First Name, Last Name: Enter Name

Doctor Phone Number: Enter Phone

Doctor Fax: Enter Fax

Doctor Address: Enter Street Address

City: Enter City

State: Enter State

Zip Code: Enter Zip

Diabetes Supplies

Prescription Medication

Other Request

Frequency of Testing: 1, 2, 3, 4, 5, 6...

Insulin Dependant? YES/NO

Group # Enter Allergies

Message to Prescription Specialist: Enter Your Message

Insurance #: Enter Text

Bin #: Enter Text

PCN #: Enter Text

Known Allergies Enter Text

Name of Medication(s) / Strength / Dosage: Enter Your Message

Compound Medication(s)* *Prescription medications can be compounded and dispensed to patients only upon receipt of a valid patient-specific prescription.