3510 Clinton Parkway Place, Suite 220
Lawrence, KS, 66047
(785) 843-0111

Transfer

Use this form to have your prescriptions transferred to Jayhawk Pharmacy.
Contact Information

Patient First Name (required)

Patient Last Name (required)

Phone Number (required)

Your Email (required)

Transfer Requests

Current Pharmacy (required)

Current Pharmacy Phone (required)

Prescriber Name (required)

Prescriber Phone # (required)

Prescription information: prescription number and medication (required)