RDMG
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Primary Email
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First Name
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Last Name
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Primary Phone
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Full Address
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Please list the name of the medications being processed through the RxProtect program.
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Due to the borders policy, a Real ID or Passport is required. Please upload a copy of your Real ID or Passport. If you do not have one, upload a copy of your driver’s license as a placeholder. Future shipments of medication will require a Real ID.
Upload a copy of the script if you have it. If not, please have your provider fax it to us directly. Fax #: 917-909-5923
Pharmacy requires past medical history and allergies for the safety of medicine interactions.
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Please list all drug allergies here. If you do not have any drug allergies please type 'n/a'.
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