Pharmacy prescription refill request
Complete form and click submit request button to send refill request to the selected pharmacy.
Attention Specialty Pharmacy Patients
: This form should NOT
be used to submit Specialty Pharmacy refill requests. Please contact Specialty Pharmacy at 844-730-5913 (toll-free) or 859-218-5413 to refill your prescriptions.
Please provide contact information
Please provide date of birth*
Please select a pharmacy location*
Please select delivery method*
If you don’t know your prescription numbers, please put the drug names here.
Please provide the Rx# for each refill request *
Additional time will be required to refill the prescription.
University of Kentucky Notice of Privacy Practices
If the delivery method is PICKUP and the refill is AVAILABLE for pickup, please allow at least 4 hours before
picking up a refill that has been requested online.
We ask for your name and e-mail address so that we can contact you about your refills, if necessary.
Your e-mail address will be kept private and will not be sold or added to any mailing lists.