Community Pharmacy of Cornish

200 Maple St.
Cornish, ME 04020
Store: 207-625-8050
Fax: 207-625-4628
Mike Coppi, R.Ph
cornishrx@communityrx.com
Store Hours:
Monday – Friday: 8:00am – 7:00pm
Saturday: 8:00am – 2:00pm
Closed Sunday   
 

Prescription Refill Form:

1. Who is this Prescription for?
Please enter your last name and phone number exactly as it appears on your prescription label.

Last Name (Required) Phone (Required) E-mail Address (Required)

2. Which prescriptions would you like refilled?
Please enter your Community Pharmacies prescription number(s) from your medicine container.

Prescription 1 (Required) Prescription 2   Prescription 3   Prescription 4

3. Arrange for pickup or mailing of your prescription(s)?
     Please choose one of the options below

 I will pick it up.
     A date and time for pickup must be selected if you are choosing this option.
     Please allow at least three hours for your prescription to be filled.

Pick Up Date: Pick Up Time: 

 Please Mail It.
       I understand that shipping may apply if I live outide of Maine.
       If your mailing address has changed please contact us at the
       location listed above. 
 

4. Verify information and submit your order.

By clicking on "Submit Refill" you confirm that you are the patient named, or the authorized caregiver for that patient. You further confirm that all the information you are submitting is correct.

To ensure the accuracy of your order we may contact you with questions concerning this refill request.

Please click the "Submit Refill" button and your refill request will be sent to the Community Pharmacies store listed at the top of this page.

Additional Comments: