Refill Request

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Patient Information
Enter Rx Numbers
Shipping Details
Shipping Address
Shipping Method
Cold shipping will default to 1 day shipping at *$41.00
*Ak/HI/PR/Guam price apply: 1 Day - $35.00, 2 Day - $50.00 and Cold - $58.00
Signature Confirmation
Any orders that contain a controlled substance or have a total cost that exceeds $100 requires a signature at the time of delivery. If the waive signature option is selected, Empower Pharmacy will not be held financially responsible for your order if the package is lost or stolen.
  • I acknowledge all of the information provided above is correct and I authorize Empower Pharmacy to process my refill and charge my credit card.
  • Most refill orders are processed within 7 business days of the request