This form is for Bridgercare patients picking up refills at the clinic. We require 1 business day to process your order.
For refills to be mailed or transferred to a pharmacy, do not use this form: call us at 406-587-0681 during office hours.
If someone else is picking up for you, please include their name in the message of your order.
You can also order condoms for pickup! Condoms are $2 for a bag of 10 and are offered on the sliding fee scale.
Email address must be valid. This refill message is secure and encrypted for your privacy.