7150 Jefferson Hwy., Suite 680
Baton Rouge, Louisiana 70806
Phone: (225) 364-2847
Fax: (225) 364-2852
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Refill RX
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First Name:
First Name
*
Last Name:
Last Name
*
Refill #:
Refill #
*
Pickup Date:
mm/dd/yyyy
*
Pickup Time:
Hour
Minute
10
11
12
1
2
3
4
5
00
15
30
45
Additional Comments:
Refilling your prescription is simple at Bocage Pharmacy Centre
Please allow 1 - 2 hours for your refill to be processed and filled before picking up.