Delivery Request Form - During Coronavirus NO FEE
First Name *
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Last Name *
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Date of Birth *
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Phone number *
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Street Address *
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City *
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State *
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Zip Code *
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Other Comments
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Please Note
If medications have a copay amount, Legacy Community Health Pharmacy will call for payment collection prior to shipping. Medication shipment generally takes 3-5 days for arrival.

For more information about Legacy Community Health Pharmacy, please visit our website:
www.LegacyCommunityHealth.org/Pharmacy
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