Transfer Pharmacies

See how we can make a difference in your life

Transfer your pharmacy to us online

Please completely fill out the form below. We will be able to process your transfer within 1-2 business days.

If you do not have refills left, you will be notified and we will attempt to contact your physician on your behalf to accommodate your request.

Note: If you have multiple Rx numbers, please put each Rx number on its own line in the box below.

Transfer from your Pharmacy to our Charlie's Pharmacy

Pharmacy Name*
Pharmacy Number*
Your Prescription(s)*
Please include the prescription (RxN) number, drug name, and strength. If you have multiple prescriptions, add one line for each prescription. See example placeholder.
Or Upload Your Prescription
Accepted file types: jpg, gif, png, pdf, docx, tiff, jpeg.
Patient Name*
First Last
Phone*
Email*
Date of Birth*
Date Format: MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State ZIP Code
Delivery or Pickup?*
- Delivery
- Pickup