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American Family Children's Hospital
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Step 2 of 3 - Enter Prescription Information

Pharmacy Selected

 UW Specialty Mail Service Pharmacy | Change Pharmacy
 * = Required

* Enrollment I am enrolled in the mail-order program.

Contact Information

* First Name
* Last Name
* E-mail Address
* Confirm E-mail Address
* Phone Number
   Alternate Phone Number

Prescription Numbers

* 1
2
3
4
5
Select this button if you have more than five prescriptions to refill. Then enter the additional prescription numbers in the fields provided.

Delivery Information

* Delivery Method
Mail-out
Pick-up
Delivery
   Comments
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INSTRUCTIONS

Provide all requested information in the available fields. Fields with an asterisk (*) are required. When all information is complete and accurate, select the Process Order button.

 
 
 

PHARMACY INFORMATION

UW Specialty Mail Service Pharmacy
5249 E. Terrace Dr.
Madison, WI 53715
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608-263-1292
Hours: 8am-6pm, Monday-Friday