Clinic Pharmacy - Salem, KY
Order Prescription Refills
Home
Order Prescription Refills
Diabetic Shoes and Supplies
Flu Shots
Digital Prints
Our Services
Meet the Pharmacists
Medicare Part D
Insurance
Heritage Days
Health Fair
Hours and Directions
Patient Resources
Privacy Practives
Contact Us

  • Orders will be precessed upon receipt unless otherwise requested.
  • Delivery or mail orders should be submitted before 10AM to ensure same day mailing or delivery.
Order Form
 
TAB key will move to next box.
ENTER key will submit the order.

Full Name:
Phone Number:
Email Address:
Pick Up, Delivery, or Mail
Prescriptions Needed: (numbers or names)
Comments, special instructions, or OTC Items
  

  • It's ok to include more than one person's order on this form. (e.g. a husband and wife, a parent and a child, etc.)
  • If a Mail-out or Delivery, please let us know your current address if we did not previously have it.
  • Please be sure to include your phone number and email address so we can contact you if we have any questions.

Clinic Pharmcy, 141 Hospital Dr, PO Box 498, Salem, KY 42078

(270) 988-3230