132 S. Main St.
Jefferson, WI 53549
(920) 674-5733

Products and Services at The Drug Store Include:

FlavorX- Making Medicine Taste Better
Hallmark Cards and Gifts Available
Florajen and Florajen-3 Products Available

Refill Request

Please fill out this form and click "Submit Refill Request" to request refills.

First Name:
Last Name:
Phone Number:
Prescription 1:
(Enter Rx #)
Prescription 2:
(Enter Rx #)
Prescription 3:
(Enter Rx #)
Prescription 4:
(Enter Rx #)
Prescription 5:
(Enter Rx #)
Prescription 6:
(Enter Rx #)
Additional refills needed or helpful comments:

Please select how you will receive your prescription:

Pick-up at Store Delivery

Please Enter the Security Code as Displayed Above:

* For your convenience The Drug Store offers prescription delivery to the Greater Jefferson Area. Please submit your refill request by 2:00pm if you would like same day delivery.

* Please allow 1 hour for processing after submitting your refill request.

Store Hours

Monday - Friday: 8:30am to 5:30pm
Saturday: 8:30am to 12:00pm

For Your Convenience - Securely Request Your Refill Online Anytime - Click Here

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