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Call (413) 577-5000

Prescription Refill Request

Complete the form below to refill your prescription from the UHS Pharmacy.

Important:

  • Online ordering is only for refills of prescriptions from the UHS Pharmacy. New prescriptions must be delivered to the pharmacy in person or requested by your healthcare provider.
  • The UHS pharmacy can only fill prescriptions written for patients who are currently registered and receiving services at UHS.
  • You must have refills remaining on your prescription to use online ordering. Check the label on your medication; if no refills remain, contact your UHS provider for a prescription. (Not sure how to read the label? Click here for a sample.)
  • Please allow one business day for your request to be processed. Refills are subject to medication availability.
  • If you have questions or concerns about your prescription, or if there are changes to your personal information or insurance coverage, call the UHS Pharmacy, (413) 577-5030.
  • All personal information submitted on this form is covered by UHS’ privacy practices.
First Name: 
Last Name: 
Phone Number:  
Prescription Numbers:
(Click here for a sample)
 











Desired Pickup Time: