Transfer Prescription

To transfer your Rx Prescription to Cordova Bay Pharmacy, please fill out the below information.

Your Name
First Name
Last Name
Your Phone Number
Area Code
Phone Number
Current Pharmacy's Name
Pharmacy's Address
Street Address
Street Address Line 2
City
Province
Postal Code
Pharmacy's Phone Number
Area Code
Phone Number

Please note: We reserve the right to contact you if we need additional information about your personal health information. Additionally, we reserve the right to disallow your transfer request if a conflict of interest exists.

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