Let's Start
First Name
Last Name
Email Address
Phone Number
How did you hear about Drug Mart?
step 1
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Shipping
Street Address 1
Address Line 2
City
State
Zip Code

Please make sure this address matches your primary residence.

step 2
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Profile
Date of Birth
Gender
Medication Allergies
Health Conditions

Information on this site is protected with up to 256-bit SSL Encryption.

step 3
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Doctor & Pharmacy
Doctor's Name
Doctor's Phone Number
Name of Previous Pharmacy
Previous Pharmacy's Phone Number
Additional Doctors (Specialists)

It may save time later if you tell your doctor to update the pharmacy in your file.

step 4
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Add Insurance
Insurance ID Number
Rx BIN Number
Rx Group
Rx PCN
Insurance Phone Number

Leave this blank and click Next step to continue without insurance.

step 5
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Add Medications
Medication Name(s)
Message
Vitamins
Supplements

We're ready to work with you and your doctor to provide exceptional care.

step 6
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Next step
Congratulations!

Exceptional care begins here.

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