Southgate Pharmacy :: Online RX

Use this form if you are transferring from a different pharmacy or would like to fill a new prescription.

If you need to refill your prescription and know your user ID, Password and Keycode click the Rx Refill button on the main menu at the top of the page.

Please enter your information
Name:
Address:
City:
State:
Zip:
Phone:
Email:

Enter prescription number(s):
Rx NO.	Drug Name / Description
1.
2.
3.
4.
5.
6.

Delivery / Pickup Options
Delivery or Pickup
For delivery, please specify address
Address:
City:
Preferred Pickup Time:

Special Instructions

Optional Information

Store Transferring from: Store Location:

Your use of this website constitutes acceptance of the Southgate Privacy Policy and Terms & Conditions