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1

Search for medications or formulations to prescribe.

2

Click Order Medication and fill out order form.

3

Print and fax it to the pharmacy at 401-284-4506.

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Visit the Tutorials tab to learn more.

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1

Circle for steps.

Patient Information

Last Name

First Name

MI

Address

Apt. #

City

State

ZIP

Phone #

Date of Birth

Sex

Male

Female

Email

Patient will pick up at pharmacy

Please ship to patient

Please ship to office

2

Circle for steps.

Prescriber and Prescription Information

Prescriber's First Name

Prescriber's Last Name

Phone Number

Fax Number

Address

City

State

ZIP

NPI/DEA

Add

Adding

Radio 3

CheckboxAzelaic Acid 15%/Niacinamide 4% Topical Cream

Add

Adding

Radio 3

CheckboxAzelaic Acid 15%/Metronidazole 1%/Oxymetazoline HCl 1% Topical Cream

Add

Adding

Radio 3

CheckboxAzelastine HCl 0.1%/Clobetasol Propionate 0.05% Topical Gel

Add

Adding

Radio 3

CheckboxAzelaic Acid 15%/Metronidazole 1.2% Topical Gel

Add

Adding

Radio 3

CheckboxAzelaic Acid 15%/Salicylic Acid 2%/Ascorbic Acid 1% Topical Cream

Add

Adding

Radio 3

CheckboxAtovaquone 250 mg/5 ml/Proguanil HCl 100 mg/5 ml Oral Suspension

Add

Adding

Radio 3

CheckboxAzelaic Acid 5%/Progesterone 2%/Minoxidil 5%/Liothyronine 2 Mcg/ml Shampoo

Add

Adding

Radio 3

CheckboxAzelaic Acid 5%/Minoxidil 5% Topical Foam

Add

Adding

Radio 3

CheckboxAtropine Sulfate 0.01%, 0.02% and 0.05% Ophthalmic Solution

Add

Adding

Radio 3

CheckboxAtomoxetine 6 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxAzathioprine 50 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxAtorvastatin 2%/Cholesterol 2% Topical Gel

Add

Adding

Radio 3

CheckboxAtomoxetine 4 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxAtorvastatin 50 mg/ml Oral Suspension (Vet)

Add

Adding

Radio 3

CheckboxAtropine Sulfate 0.2% Vaginal Cream

Add

Adding

Radio 3

CheckboxAtropine Sulfate 1% Sublingual Oral Drops

Add

Adding

Radio 3

CheckboxAtropine Sulfate 0.54% Topical Cream

Add

Adding

Radio 3

CheckboxAtenolol 50 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxAzelaic Acid 5%/Clindamycin 2% Topical Cream

Add

Adding

Radio 3

CheckboxAzelaic Acid 1%/Progesterone 1% Topical Cream

Add

Adding

Radio 3

CheckboxAttapulgite 40 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxAzathioprine 50 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxAtropine Sulfate 1 mg Troche

Add

Adding

Radio 3

CheckboxAzelaic Acid 5%/Ketoconazole 2% Topical Solution

Add

Adding

Radio 3

CheckboxAtorvastatin 1 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxAzathioprine 0.5% Topical Gel

Add

Adding

Radio 3

CheckboxAtorvastatin 20 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxAspirin 7.5% Topical Gel

Add

Adding

Radio 3

CheckboxAspirin 325 mg/5 ml Oral Suspension

Add

Adding

Radio 3

CheckboxAspirin 325 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxAtenolol 6.25 mg/0.1 ml Topical Gel (Vet)

Add

Adding

Radio 3

CheckboxAspirin 250 mg Suppository

Add

Adding

Radio 3

CheckboxAspirin 650 mg/5 ml Oral Suspension

Add

Adding

Radio 3

CheckboxAspirin 500 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxAtenolol 6.25 mg/0.1 ml Topical Cream (Vet)

Add

Adding

Radio 3

CheckboxAspirin 13.3% Dental Paste

Add

Adding

Radio 3

CheckboxAtenolol 12.5 mg Capsules

Add

Adding

Radio 3

CheckboxAtenolol 2 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxAspirin 650 mg Suppository

Add

Adding

Radio 3

CheckboxAspirin 385 mg/Caffeine 30 mg/Orphenadrine Citrate 25 mg Capsules

Add

Adding

Radio 3

CheckboxAspirin 325 mg Suppository

Add

Adding

Radio 3

CheckboxAtenolol 25 mg Capsules (Gluten Free)

Add

Adding

Radio 3

CheckboxAscorbic Acid 12% Topical Gel

Add

Adding

Radio 3

CheckboxAscorbic Acid 500 mg/Vitamin E Acetate 400 Iu/Zinc 80 mg/Copper 2 mg Oral Effervescent

Add

Adding

Radio 3

CheckboxAscorbic Acid 15%/Urea Clear 10% Topical Lotion

Add

Adding

Radio 3

CheckboxAscorbic Acid 250 mg Polyglycol Troche

Add

Adding

Radio 3

CheckboxAscorbic Acid 500 mg/5 ml Oral Syrup

Add

Adding

Radio 3

CheckboxAspirin 5% Dry Socket Paste

Add

Adding

Radio 3

CheckboxAspirin 5%/Lidocaine 2% Topical Gel

Add

Adding

Radio 3

CheckboxAscorbic Acid 750 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxAscorbic Acid 15% Nasal Spray

Add

Adding

Radio 3

CheckboxAscorbic Acid 10% Topical Cream

Add

Adding

Radio 3

CheckboxAscorbic Acid 15%/Glycolic Acid 4%/Arbutin 4% Topical Serum

Add

Adding

Radio 3

CheckboxAscorbic Acid 250 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxAscorbic Acid 25% Vaginal Gel

Add

Adding

Radio 3

CheckboxAscorbic Acid 10% Topical Gel

Add

Adding

Radio 3

CheckboxAscorbic Acid 250 mg Suppository

Add

Adding

Radio 3

CheckboxAscorbic Acid 500 mg Slow Release Capsules

Add

Adding

Radio 3

CheckboxAscorbyl Palmitate 10% Topical Lotion

Add

Adding

Radio 3

CheckboxAscorbic Acid 10%/Niacinamide 5% Topical Gel

Add

Adding

Radio 3

CheckboxAscorbic Acid 15%/Glycolic Acid 4%/Salicylic Acid 1% Topical Serum

Add

Adding

Radio 3

CheckboxAscorbic Acid 10%/Dehydroepiandrosterone 10% Topical Cream

Add

Adding

Radio 3

CheckboxAscorbic Acid 5%/Sodium Hyaluronate 0.75% Topical Serum

Add

Adding

Radio 3

CheckboxArginine 8.7%/Glycolic Acid 6% Topical Cream

Add

Adding

Radio 3

CheckboxArbutin 2%/Kojic Acid 1% Topical Cream

Add

Adding

Radio 3

CheckboxArginine HCl 700 mg Capsules

Add

Adding

Radio 3

CheckboxArginine HCl 1%/Naltrexone HCl 1%/Aloe Vera 0.2%/Misoprostol 0.0024% Topical Gel

Add

Adding

Radio 3

CheckboxArginine HCl 6%/Sildenafil 2%/Nifedipine 0.2% Topical Cream

Add

Adding

Radio 3

CheckboxArginine HCl 6%/Nifedipine 0.2%Topical Cream

Add

Adding

Radio 3

CheckboxArginine 30% Topical Cream

Add

Adding

Radio 3

CheckboxAscorbic Acid 0.6%/Chlorhexidine Gluconate 0.15% Oral Rinse

Add

Adding

Radio 3

CheckboxArginine 8.7%/Glycolic Acid 6% Topical Gel

Add

Adding

Radio 3

CheckboxArginine HCl 1%/Naltrexone HCl 1%/Misoprostol 0.0024%/Aloe Vera Topical Gel

Add

Adding

Radio 3

CheckboxAscorbic Acid 0.225%/Pyridoxine HCl 0.15%/Vitamin E Acetate Nasal Spray

Add

Adding

Radio 3

CheckboxArginine HCl 750 mg Capsules

Add

Adding

Radio 3

CheckboxArginine HCl 11.7%/Sildenafil 1%/Naltrexone HCl 0.817% Topical Cream

Add

Adding

Radio 3

CheckboxArginine 400 mg/Gm Rectal Paste

Add

Adding

Radio 3

CheckboxAripiprazole 1 mg/ml Oral Suspension

Add

Adding

Radio 3

CheckboxApomorphine HCl 3% Topical Paste

Add

Adding

Radio 3

CheckboxArginine 12 mg/Papaverine HCl 0.2 mg Rapid Dissolve Vaginal Tablet

Add

Adding

Radio 3

CheckboxApomorphine HCl 10% Topical Paste

Add

Adding

Radio 3

CheckboxArginine HCl 1% Topical Cream

Add

Adding

Radio 3

CheckboxArginine HCl 6%/Sildenafil 2%/Nifedipine 0.2% Topical/Vaginal Gel

Add

Adding

Radio 3

CheckboxAscorbic Acid 1% Wound Dressing (Vet)

Add

Adding

Radio 3

CheckboxAscorbic Acid 1%/Phytonadione 1% Topical Cream

Add

Adding

Radio 3

CheckboxAscorbic Acid 5%/Lidocaine HCl 3.5%/Menthol 0.25% Topical Gel

Add

Adding

Radio 3

CheckboxAnthralin 0.5% Topical Cream

Add

Adding

Radio 3

CheckboxAnastrozole 0.1 mg/0.2 ml Sublingual Drops

Add

Adding

Radio 3

CheckboxAntipyrine 0.3% Throat Spray

Add

Adding

Radio 3

CheckboxAnastrozole 0.25 mg Capsules

Add

Adding

Radio 3

CheckboxApomorphine HCl 2 mg Polyglycol Troche

Add

Adding

Radio 3

CheckboxApomorphine HCl 3 mg Troche

Add

Adding

Radio 3

CheckboxAnastrozole 0.1% Topical Cream

Add

Adding

Radio 3

CheckboxAnastrozole 0.25 mg/0.5 ml Sublingual Drops

Add

Adding

Radio 3

CheckboxAnthralin 0.1%/Salicylic Acid 2% Topical Cream

Add

Adding

Radio 3

CheckboxAnastrozole 0.1% Topical Gel

Add

Adding

Radio 3

CheckboxAnastrozole 1 mg/ml Topical Solution

Add

Adding

Radio 3

CheckboxAntipyrine 5.4%/Benzocaine 1.4% Otic Solution

Add

Adding

Radio 3

CheckboxApomorphine HCl 3 mg Oral Polyglycol Troche

Add

Adding

Radio 3

CheckboxApomorphine HCl 3 mg Ophthalmic Nonsterile Capsules (Vet)

Directions:

QTY:

Refills

1

2

3

4

5

6

7

8

9

10

xPrescriber's Signature:

Date

3

Circle for steps.

Fill out the Pharmacy Name and Fax Number, then fax it to the Pharmacy.

Pharmacy Name

Pharmacy Fax Number

You may need to scale up or down your order form when printing to make it fit the page.

Thank you! Your submission has been received!

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