McGuff Pharmacy Main Page Services	We Appreciate Your Continued Confidence in the McGuff Compounding Pharmacy! Please fill out this form to so that we may provide you a refill.  We will process your refill during regular business hours. Complete the required fields (indicated with an *) and click Submit.   Bill To Information: * Patient Name MI * Last Name   * Address 1         Address 2         *City *State *Zip Code Alabama Alaska Arkansas American Samoa Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Nothern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virgina Wisconsin Wyoming *Phone Number Fax Number Contact Name * E-mail address             The Prescription number will be found on every invoice on the first line of each line item. It will also appear on the label that is attached to each product.       * Prescription Number 1 Example:   0080030-950001   * Prescription Number 2         * Prescription Number 3               Shipping Instructions Click Here for Service Map   UPS 3 Day Air - Standard UPS Ground Service - Least Expensive UPS 2 Day Air UPS Overnight           Please charge my credit card, VISA Master Card Discovery American Express as previously provided.             Please indicate how we should inform you of the shipment of your refill. E-Mail Invoice on the shipment Telephone FAX
	Ship To Information (If different than Bill To Information) Name               * Address 1         Address 2         *City *State *Zip Alabama Alaska Arkansas American Samoa Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Navada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Nothern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virgina Wisconsin Wyoming *Phone Number Fax Number     Contact Name         * E-mail address

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