Schedule Prescription Delivery | Fast Service by TranXmedi

Schedule Pick Up Delivery

Name(Required)

First Last

Email(Required)

Your Phone Number

Which Pharmacy Are We Picking Up From?

**PLEASE NOTE THAT WE ONLY PICK UP AND SERVICE Berks County and Lancaster County, PA

Select If We Are Picking Up Prescription Or Device/ Equipment

Prescription

Device/Equipment

Type Of Device/Equipment

Pharmacy Address

**PLEASE NOTE THAT WE ONLY PICK UP AND SERVICE Berks County and Lancaster County, PA

Street Address City State ZIP / Postal Code

Delivery Address

**PLEASE NOTE THAT WE ONLY PICK UP AND SERVICE Berks County and Lancaster County, PA

Street Address City State ZIP / Postal Code

Pick Up Date

Monday-Saturday

This address is a:

Subject(Required)

Comments(Required)

Pickup Notification(Required)

By checking this box you are confirming that you have notified the pharmacy that we are picking up your medications.

Total

Pick Up Fee

Price:

Payment Method

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Total

Email

This field is for validation purposes and should be left unchanged.