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You may call to order by phone to expedite the refill.",{"name":69,"@type":60,"acceptedAnswer":70},"What payment method is required and what happens without payment?",{"text":71,"@type":63},"Pre-payment is required for all orders. 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Box 8  \nFremont, NE. 68026 1-800-228-3108  \n\n| \u003Cbr>\u003Cbr>SAV-RX MAIL ORDER FORM  |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| Name:\u003Cbr>| ID\\#: | Group \\#: | |  |\n| Address:\u003Cbr>| City | State | Zip | |\n|  Daytime Phone: | Evening Phone: | |  |  |\n|  Patient Name (if prescription is for other than the cardholder) | Patient Date of Birth: | |  |  |\n\n\n| \u003Cbr> NEW PRESCRIPTION |  |  |  |  |  |  |  |  | Place Refill Sticker(s) here or complete the information.\u003Cbr>Refill Rx\\#  Drug Name \u003Cbr>Refill Rx\\#  Drug Name \u003Cbr>Refill Rx\\#  Drug Name \u003Cbr>Sav-Rx does not hold prescriptions. Please send only prescriptions to be ordered immediately. Once an order has been processed, it cannot be stopped. We will not accept returns of accurately dispensed medications. |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n|  | 1. Complete the information above\u003Cbr>2. Include your original prescription(s) in an envelope\u003Cbr>3. Include Credit Card information or payment\u003Cbr>* Note: Your physician may phone in your order to 1-800- 228-3108 or fax your order to 1-888-810-1394 |  |  |  |  |  |  |  |  |  |  |  |\n|  REFILL\u003Cbr>|  |  |  |  |  |  |  |  |  |  |  |  |\n|  | 1. Complete the information above\u003Cbr>2. Place refill sticker on this sheet or refill Rx\\# and drug name. The refill sticker is on the right side of the prescription information that arrived with your previous prescription order.\u003Cbr>3. Include Credit Card information or payment\u003Cbr>4. To expedite your refill order, you may call 1-800- 228-3108 to order by phone. |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  | Please charge my Credit Card Check One!  |  |  | |  | | Credit Card Expiration Date:\u003Cbr>Month:  Year:  |  |  |  |  |  |\n|  | Credit Card Number: |  |  |  |  |  |  |  |  |  |  |  |\n| |  | Cardholder Signature: Date: |  |  |  |  |  |  |  |  | |  |\n| Personal Check or Money Order enclosed. If providing payment by personal check, make payable to Sav-Rx and provide your ID\\# on the check. Mail payment and prescription to Sav-Rx P.O. Box 8 Fremont, Ne. 68026\u003Cbr>PRE-PAYMENT IS REQUIRED FOR ALL ORDERS. IF YOU NEED CURRENT PRICING PLEASE CALL 1-800-228-3108 TO SPEAK DIRECTLY WITH A CUSTOMER SERVICE REPRESENATIVE. ANY ORDERS RECEIVED WITHOUT PAYMENT COULD BE DELAYED.\u003Cbr>|  |  |  |  |  |  |  |  |  |  |  |  |\n\nBy checking this box, I elect to receive brand name drugs for all prescriptions in this order. I understand I am responsible for the brand co-payment, which may be higher.","cbCaihuwYxQ2w2xe","https://ap.wps.com/l/cbCaihuwYxQ2w2xe","pdf",262563,"English","# New Prescription\n## Refill\n# Payment and Ordering Instructions","[{\"question\":\"How do I place a new prescription order by mail?\",\"answer\":\"Complete the information on the form, include your original prescription(s) in an envelope, and include credit card information or payment.\"},{\"question\":\"How should I submit a refill request?\",\"answer\":\"Place refill sticker(s) on the sheet or provide the refill Rx# and drug name, then include credit card information or payment. You may call to order by phone to expedite the refill.\"},{\"question\":\"What payment method is required and what happens without payment?\",\"answer\":\"Pre-payment is required for all orders. Orders received without payment could be delayed; credit card details or personal check/money order must be provided as instructed.\"}]","SAV-RX Mail Order Form - Complete and Send Prescription or Refill | PDF",1789633376]