My Drug Cost & Manifest Pharmacy

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BOGO OFFER

AMLODIPINE, ATORVASTATIN, LISINOPRIL, METFORMIN, METFORMIN ER

Each Medication: $20 for a 90-day supply.

BOGO

• Choose 2 medications and you'll receive 1 of them for free. Choose 4 medications and you'll receive 2 of them for free.

RX

• Tell us how we can obtain your current prescriptions (pharmacy transfer, call MD)

PAY

• Once your prescriptions are obtained, you'll receive a secure text message to confirm your delivery address and pay.

SHIP

• Medications ship for FREE via 2-3 day priority mail

REFILL

• We will contact you 10-14 days before your next refill, so you never run out of medication

Medication 1

Medication 2

Medication 3

Medication 4

Your Full Name

Your Email

Phone Number

Birthday (MM/DD/YYYY)

Address

City

State

Zip

Other medications

Do you have any drug allergies?

Yes

Please list your allergies

No

Other medical conditions

2 Ways For Our Pharmacy To Obtain Your Prescriptions:

Transfer Your Prescription To Us (Currently Unavailable)

Previous Pharmacy Info

Tell us about your current pharmacy so we can transfer your medications

Pharmacy Name

Pharmacy Phone Number

Pharmacy City

Pharmacy State

How long until you run out of your medication?

Prescriptions

Add the medication name and Rx number for all that you'd like to transfer

Medication Name

Rx Number

Medication Name

Rx Number

Medication Name

Rx Number

Medication Name

Rx Number

We Will Call Your Doctor (Currently Unavailable)

Doctor Full Name

Phone Number

Full Address

Notes for Pharmacy (Optional)

Your message