Welcome back to Mandell's Clinical Pharmacy! It's great to see you again. Please enter your information below to proceed with your medication order.
Once you are finished completing this form, we recommend that you visit www.MandellsPharmacy.com/Save to review discount programs.  We recommend you apply for Compassionate Care to determine if you qualify for additional savings based on your income.  
Please retrieve your prescription card - you may have one insurance card or two. If you have one, there will likely be prescription related information on it.  If you have two cards, please verify that you have your prescription card - a good way to tell is there will be "RX" information on the card.
Once you confirm you have the correct card, please enter it below by either taking a picture of the front and back, or manually entering the information. Please note that any incomplete or inaccurate informtion could delay or prevent successful investigation of your insurance. 

If you did not provide pictures of your prescription card above, please complete the area below.