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AmeriPharma’s premier pharmacy services are available in multiple states throughout the US.

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MedBox Sign Up
You're only a few moments away from upgrading your pharmacy! We just need a few pieces of information from you to get started. We'll use this information to transfer your prescriptions to MedBox by AmeriPharma. Have a question? Our MedBox specialists can answer any questions or help you finish signing up by phone. Give us a call at 800-270-7091.

First Name
Last Name
Date of Birth
Phone Number
Can we text this phone number?
Email Address
Shipping Address (including city, state, and ZIP)
Allergies
Conditions (ex. diabetes, stroke)
Insurance & Current Pharmacy Information

Use the information located on your insurance card to complete this step. We only use this information to provide you with the best service possible, and we never share it with anyone else. Have a question? Our MedBox specialists can answer any questions or help you finish signing up by phone. Give us a call at 800-270-7091.

Medicare # or SSN
Insurance ID Number
RxBIN Number
RXPCN Number
RxGroup Number (also RxGRP)
Current Pharmacy Name
Current Pharmacy Phone Number
Preferred MedBox Start Date
Prescription Information

Please gather all your prescription bottles and line them up. Using the information found on each bottle, please fill out the form below. Have a question? Our MedBox specialists can answer any questions or help you finish signing up by phone. Give us a call at 800-270-7091.

Please list the Drug Name, Strength, Directions, Time(s) medication is taken for each prescription Example: 1. metFORMIN HCL, 500mg, Take twice a day 12 hours apart, 8AM 8PM 2. glipiZIDE, 5mg, Take once a day with food, 8AM

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I take more than 8 medications
Prescription Information Part 2

You're almost there! Have a question? Our MedBox specialists can answer any questions or help you finish signing up by phone. Give us a call at 800-270-7091.

Please list the Drug Name, Strength, Directions, Time(s) medication is taken for each prescription Example: 1. metFORMIN HCL, 500mg, Take twice a day 12 hours apart, 8AM 8PM 2. glipiZIDE, 5mg, Take once a day with food, 8AM

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I take more than 16 medications
Prescription Information Part 3

You're almost there! Have a question? Our MedBox specialists can answer any questions or help you finish signing up by phone. Give us a call at 800-270-7091.

Please list the Drug Name, Strength, Directions, Time(s) medication is taken for each prescription Example: 1. metFORMIN HCL, 500mg, Take twice a day 12 hours apart, 8AM 8PM 2. glipiZIDE, 5mg, Take once a day with food, 8AM

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I take more than 24 medications
Prescription Information Part 4

You're almost there! Have a question? Our MedBox specialists can answer any questions or help you finish signing up by phone. Give us a call at 800-270-7091.

Please list the Drug Name, Strength, Directions, Time(s) medication is taken for each prescription Example: 1. metFORMIN HCL, 500mg, Take twice a day 12 hours apart, 8AM 8PM 2. glipiZIDE, 5mg, Take once a day with food, 8AM

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Vitamins and Other Pharmacy Items

You can include vitamins, supplements, and over-the-counter medications inside your MedBox packets. If you would like any of these added to your MedBox, please list them here. You can also list any other pharmacy items like inhalers or creams. Have a question? Our MedBox specialists can answer any questions or help you finish signing up by phone. Give us a call at 800-270-7091.

List the Name, Strength, Time(s) each pill is taken. Example: 1. Fish Oil, 500mg, Once a day in the morning 2. Vitamin B, 100mg, Twice a day morning and night

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