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  • Refill Request Form

    Hello! Please fill in the form below. Thanks!
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  • Please Take a Photo of the Front and Back of your Prescription Insurance Card (We will need the RX BIN, PCN, GRP, and ID.)

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  • Thank you! Feel free to text/call us at 212-749-6626 or email us at Hi@ahmarx.com with any questions.

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