Online Transfers

To transfer your prescriptions to Carolina Apothecary, simply complete the transfer request form below and click submit.

* Indicates a required field.

First Name:*

Last Name:*

Date of Birth:* (mm/dd/yyyy)

Prescription# or Name:

1.*

10.

Current Pharmacy Name:*

Current Pharmacy Phone Number:*

Delivery Method:*

Pick Up Time:*

Phone Number:*

Email Address:

Address: (only required for delivery)

City:

State:

Zip:

Please include any comments about your prescription transfer

Comments: We respect your email privacy and promise to never sell, barter, share or rent your email address to any unauthorized third party.