Rx Referral Forms

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Rx Referral Forms

Please print and fill out one of the following forms: RX Referral forms provided are for the use of authorized prescribers only.

Premier Pharmacy Services can accept only original prescription drug orders from patients, and faxed prescription may only be accepted from authorized prescribers.

Please mail original prescription drug orders to:

Premier Pharmacy Services
410 Cloverleaf Dr.
Baldwin Park, CA 91706

Please fax prescription drug orders to:

800-540-3400 or 626-626-9840

Licensed in all 50 states.