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  • When you transfer your prescription to our pharmacy, you receive a gift card as our way of showing our appreciation. You get a 10-dollar gift card when you transfer 2 maintenance medications and a 25-dollar gift card when you transfer 4 maintenance medications.
  • Please note that Medicaid, Medicare, and any other federal and state government or other publicly funded program prescriptions are not eligible. A maximum of 25 dollars per customer will be given. These gift cards are not valid on prescriptions for controlled substances where prohibited by law.
  • To begin the process of transferring your prescription, please fill out the form below with the needed information. Thank you for making Collins Pharmacy your pharmacy of choice!

Fill Prescription form

PRESCRIPTION TO BE TRANSFERRED

If you would like to transfer all prescription, simply check the box below.

If you would like to selectively transfer your prescription, use the option below.

LIST SPECIFIC PRESCRIPTION TO BE TRANSFERRED

MEDICATION NAME

PRESCRIPTION NUMBER FROM CURRENT PHARMACY

Submit