Rosemark - WomenCare Specialists
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Rosemark Online Pharmacy-Prescription Refill Requests

This service is currently only available to Rosemark patients.

This online services is provided through a secure area.

Rosemark WomenCare Specialists will be held harmless should your request not get transmitted due to technical problems related to the web site. 

Your prescription request will be processed within 24 hours, during normal business hours, Monday–Friday, 8:00 am to 5:00 pm, except holidays. If you do not receive confirmation of your request, contact our office at (208) 557-2900.

On the Rosemark site all personal identifying information is encrypted. Your request will not be internally or externally forwarded to or shared with any other third parties. The information will be used only by Rosemark for the purposes intended.

 


First Name:* 
Middle Initial:* 
Last Name:* 
Date of Birth:* 
SSN#:* 
Pharmacy:* 
Pharmacy Phone #:* 
Are you pregnant? Respond Yes or No:* 
Are you Nursing? Respond Yes or no:* 
What provider prescribed to you? Doctor, Nurse Practitioner, Physicians Assistant:* 
Refill-respond yes or no and list the last fill date:* 
New prescription-Respond Yes or No:* 
What prescriptions need to be filled:* 
Notes/Additional Information:*