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Thrifty White Pharmacy has received your transfer prescription information. You will be contacted if we need additional information. Thrifty White Pharmacy has received your vaccination request. We will see you at. Thrifty White Pharmacy Store Back to Store Locator.
Phone: Directions to Store. Pharmacy Hours Monday-Friday: am to 6pm. Transfer Your Prescription. Request Your Vaccination. We're delighted you've decided to switch to Thrifty White Pharmacy. Quickly transfer your prescriptions to us from another pharmacy by filling out this form. Our pharmacists will take it from there. Current Pharmacy.
Your Information. Your Medications. New Pharmacy. Required Fields. Step 1 of 4: Identify Your Current Pharmacy. Pharmacy Name:. Pharmacy Address:. Pharmacy City:. Pharmacy Zip Code:. Pharmacy Phone:. Step 2 of 4: Your Personal Information. First Name:. Last Name:.
Gender: Female Male. Birth Date:. Zip Code:. Cell Phone:. Insurance Company Name:. Insurance BIN:. Insurance PCN:. Insurance Group :.
Insurance ID :. By providing your phone and address, you authorize us to contact you in connection with pharmacy services, health care and your via live and autodialed calls at the phone provided above. Your consent is not a condition of purchase or receipt of services and may be revoked at any time. Your carrier's message and data rates apply. Step 3 of 4: Prescriptions. Transfer All My Medications. Medication Step 4 of 4: Select your new Thrifty White Pharmacy. Grand Ave. Main Ave.
Pokegama Ave. Security Check: Enter the characters seen in the image:. Thrifty White Pharmacists are specially trained certified immunizers, and will administer your immunization in a private, professional setting. Fill out the form below to request your vaccination.
TW Pharmacy. Step 1 of 4: Your Personal Information. Phone :. Insurance information. Existing patients may skip this section. New patients, please provide your insurance information. Step 2 of 4: Vaccines I am Interested in Receiving. Step 3 of 4: Answer the Following Questions. Please select an answer! Have you ever gotten the vaccine s they are about to receive today? In past years.
Do have allergies to medicine, foods ex. Eggsa vaccine component, or latex? Have you ever had a severe reaction after receiving ANY vaccine in the past? Do you have a long-term health problem such as heart disease, lung disease, asthma including wheezingkidney disease, metabolic disease e.
Or if this ishave they been on long-term aspirin therapy? Have you had a seizure, or brain or other nervous system problem such as Guillain-Barre syndrome?
Are you currently pregnant or planning to become pregnant in the next 3 months? Are you interested in other Thrifty White Pharmacy vaccinations and services? Do you have cancer, HIV or any other condition that weakens the immune system? Have you taken medications in the past 3 months that would weaken the immune system such as cortisone, prednisone, other steroids, or anticancer drugs, or had radiation treatments? Have you received any blood products, immune globulins or antivirals in the past year? Step 4 of 4: Select your Thrifty White Pharmacy.Dating in webster city iowa
email: [email protected] - phone:(415) 291-4442 x 6419
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