Refill Your Prescription Broken Arrow Location Have Your Prescription Number? CLICK HERE! Tulsa Location Delivery/Shipping Customers Have Your Prescription Number? CLICK HERE! Don't Have Your Prescription Number? CLICK HERE! Full Name* First Last Date of Birth* MM slash DD slash YYYY Are you a vitality program member?* Yes No If you are not a Vitality Member, you can learn more about our Vitality Program and how it could help you save money.Phone*Email Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Delivery Method Pick Up (Broken Arrow) Pick Up (Tulsa) Delivery Mail Special Requests (Please add Medication Name with request)* 53025