1. Who is this Prescription for?

Please enter your last name and phone number exactly as it appears on your prescription label.

Last Name

Phone Number

Email Address

2. Which prescriptions would you like refilled?

Please enter your Community Pharmacies prescription number(s) from your medicine container(s).

Prescription 1
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.Please mail it.Pick Up:
Pick Up Date: Pick Up Time:
A date and time for pickup must be selected if you choose the pick up option.
Please allow staff up to 24 hours to complete your online refill request.
If you need something sooner, please call the pharmacy to discuss your specific need.

Mailing:
Shipping may apply if you live outside of Maine and choose the mail option.
If your mailing address has changed please contact us at the location listed above.
Please call 207-790-2220 with payment information.

4. Verify information and submit your order.
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" button and your refill request will be sent to the Community Pharmacies store listed at the top of this page.

Additional Comments