Prescription Transfer Request

This transfer request form makes it easy for you to transfer a prescription from another pharmacy in to the Purdue University Retail Pharmacy. Simply fill out the form below to get started. If you have any questions, call us at 765-494-1374.

To transfer a prescription from the Purdue University Retail Pharmacy out to another pharmacy, please have that pharmacy call us at 765-494-1374. You do not need to fill out this form.

Your Information
Permanent Address
Your Prescription(s) Information
Prescription 1
Desired Pick-up Date and Time

Please note that we require 1 business day to transfer a request.