Good Neighbor Pharmacy
Fill out the form below to have your
prescription ready for pick up at:

      Semperts Rexall Drug Store
      735 Spruce St
      Myrtle Point, OR 97458
      (541) 572-5010
Pharmacy Hours: 
Sunday:  Closed
Monday:  8:30 AM-6:00 PM
Tuesday:  8:30 AM-6:00 PM
Wednesday:  8:30 AM-6:00 PM
Thursday:  8:30 AM-6:00 PM
Friday:  8:30 AM-6:00 PM
Saturday:  9:00 AM-3:00 PM
* First Name: * Callback Number: 
* Last Name:  Pick Up Date:
Date of Birth:   (mm/dd/yyyy) Pick Up Time: 
* Rx Number(s):
Use commas to separate if entering more than one prescription.
E-mail Address:  (if you want e-mail confirmation of this refill)
* is a required field.

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