NMCP Prescription Request Form.

This form is to request the processing of new prescriptions only. For Refills, please call 757-953-6337 or 1-866-285-1008.

  • Sunday and Federal Holiday requests will be processed on the next business day (Monday-Saturday 8 am-4 pm)

  • Paper prescriptions for controlled substance medications will need to be physically brought into the pharmacy to be processed

  • Requests submitted after 2:00 pm may not be guaranteed for same day service

  • You will receive a text once your prescriptions are ready for pick-up

  • ​Once you receive a text alert, please proceed to pharmacy kiosk and select a return-for-pick-up ticket when checking in

** Do not input any Protected Health Information (PHI) **

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This document may contain information covered under the Privacy Act, 5 USC 552(a), and/or the Health Insurance Portability and Accountability Act (PL104-191) and its various implementing regulations and must be protected in accordance with those provisions. Healthcare information is personal and sensitive and must be treated accordingly. If this correspondence contains healthcare information it is being provided to you after appropriate authorization from the patient or under circumstances that don't require patient authorization. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Redisclosure without additional patient consent or as permitted by law is prohibited. Unauthorized redisclosure or failure to maintain confidentiality subjects you to application of appropriate sanction. If you have received this correspondence in error, please notify the sender at once and destroy any copies you have made.
Don't forget to keep your family's information up-to-date in DEERS.