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We fill all prescriptions from all third party medical plans in Canada.

First Name*
Last Name*
Your Email*
Phone Number*
RX# (1)*
QTY/#Months*
RX# (2)
QTY/#Months
RX# (3)
QTY/#Months
RX# (4)
QTY/#Months
RX# (5)
QTY/#Months
Pickup Date*
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