Schedule Prescription Delivery | Fast Service by TranXmedi

Schedule Pick Up Delivery

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Name(Required)

First Last

Enter date of birth

When helping someone, please enter their date of birth.

Phone Number

Email(Required)

Name Of Pharmacy We Are Picking Up From?

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

Pharmacy Address

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

Street Address City State ZIP / Postal Code

Select If We Are Picking Up Prescription Or Device/ Equipment

Prescription

Device/Equipment(10 lbs max)

Frontdesk Pickup

Device/ Equipment Description(10 lbs max)(Required)

Pick Up Date

Monday-Saturday

Delivery Address

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

Street Address City State ZIP / Postal Code

Comment

Pickup Notification: Tranxmedi Is Not Responsible For Any Copay(Required)

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

Total

Payment Method(Required)

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name