Online Prescription Transfer

If you need to transfer a prescription from CSU Health Network to another pharmacy, please contact that pharmacy to start the process.
If you need to refill an existing prescription at CSU Health Network Pharmacy, click here to refill.

Please indicate the names of the medications, total number of medications, and date your prescription is needed.

Prescription Transfer Form

Your Name(Required)

First Last

Phone(Required)

Hidden

Phone Number(Required)

Date of Birth MM/DD/YYYY(Required)

Pharmacy Name(Required)

City

Pharmacy Phone Number(Required)

Hidden

Pharmacy Phone Number(Required)

Medications name(s) , Strength(Required)

What date do you need your prescription filled by? (MM/DD/YYYY)(Required)

ID#

Rx BIN #

Rx Group #

Rx PCN #

I have the Student Health Insurance Plan (SHIP)