For Patients & Customers

Community Pharmacy

Pharmacy Refill Requests

Thank you for choosing the St. Alexius Community Pharmacy. If you have any questions with this online process or your medications, feel free to call us at (701) 530-6906.

Refilling your prescription is a simple process. Just complete the information below and we will refill your prescription as quickly as possible.

Check this box if your personal information has changed since your last prescription refill.

Check this box if generic drugs are acceptable.

* Required Fields

* First Name

* Last Name

* Address

Address 2

* City

* State

* Zip Code

* Phone Number

* Email Address

Refill Number	Medication Name

Select Delivery Method
Community Pharmacy, 900 East Broadway

(located best at the East Patient Entrance on
the corner of Rosser and 10th Street)

At the Pharmacy

Mail the prescription

Select a Payment Method

Pay at the Pharmacy

Pay with a Credit Card

Type of Card

* Name on Card

* Expiration Date

* Card Number

* V-Code

V Code is the 3 or 4 digit number on the back of your credit card. The V code is located in the signature line or is the last 3 or 4 numbers directly after your credit card number.