My Contact Information
Your First Name*
Your Last Name*
Mailing Address*
City*
State*
Zip/Postal Code*
Email Address
Phone Number*
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My Medications
| Medication | Quantity | Price | | Remove | AMIBID DM (600/30MG) | 180 | $25.00 | | Remove | ALPRAZOLAM (0.5MG) | 90 | $15.00 | | Remove | ALLOPURINOL (300MG) | 270 | $35.00 | | Remove | ALBUTEROL SULF | 270 | $35.00 | | Remove | ALLOPURINOL (100MG) | 180 | $25.00 | | Remove | AMITRIPTYLINE (75MG) | 30 | $0.00 | | Remove | AMINOPHYLLINE (100MG) | 180 | $25.00 | | Remove | ALBUTEROL SULF | 270 | $35.00 | | Remove | AMINOPHYLLINE (200MG) | 270 | $35.00 | | Remove | ALPRAZOLAM (1MG) | 90 | $15.00 | | Remove | ACYCLOVIR (400MG) | 270 | $35.00 | | Remove | ACETAZOLAMIDE (250MG) | 360 | $45.00 | | Subtotal: | $325.00 | | Shipping: | $6.99 | | TOTAL*: | $331.99 | | » Add More Medications |
Fill out the form to the left and a representative will follow up with you to complete your order.
1st Medication (Quantity of 30) - Free
Additional medications are available at the following quantities and prices:
Quantity of 90 - $15
Quantity of 180 - $25
Quantity of 270 - $35
Quantity of 360 - $45
Prices apply to every medication on list. $6.99 for shipping and handling will be added to each order regardless of medication count.
* Please
note that the order total is an estimate and certain qualifications
must be met in order for this price to be considered final. A Discount
Medication Program representative will provide information regarding
these details in a follow-up phone call.
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