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Naval Hospital Camp Pendleton - Prescription Drop Off Form

This form is to request the processing of a new prescription only, for refills please call 760 - 364 - 9321. Your request will be ready for pick-up within 48 hours (2 business days). and you will receive a text once your prescriptions are ready for pick up.

Please note, weekends and federal holiday requests will be processed on the next business day (Monday-Friday 8:00 am - 5:00 pm).

Do not input any Protected Health Information (PHI)

Q-Anywhere is available for use by all beneficiaries. For orders placed within the last 7 days, you may use Q-Anywhere. For orders placed more than 7 days ago, please use the electronic prescription drop off form.

Patient's DOD-ID Number

If your DOD ID # is unknown, please enter ten zero's above and a pharmacy tech will reach out to you ... this may delay filling your prescription.

Patient's Name

First

Middle

Last

Suffix

Patient DOB MM/DD/YYYY

Send Prescriptions To:

If you choose a branch clinic for pickup location, it will be ready for pickup within 48 hours (2 business days).

Cell Phone Number

xxx-xxx-xxxx

Cell Service Provider

This allows us to send you a text when your prescriptions are ready for pick up

# of Electronic Scripts (MTF Provider)

# of Electronic Scripts (Network Provider)

List Medications & Additional Comments

list medications here and any additonal comments. (Example: Pregnant or breast feeding, weight of patient *if younger than 12, list of allergies)

There are emergency procedures in place in multiple states due to extreme weather. Learn More About Emergency Procedures. Live in the West Region? There is now a referral approval waiver in place through April 30, 2025. Learn More About The Referral Approval Waiver. Also, you have until April 30 to set up your payment info if you pay by EFT, credit card, or debit card. This is for TRICARE Prime, TRICARE Select, TYA, TRS, and TRR plans. If you miss this deadline, you will be disenrolled back to Jan. 1. Visit www.tricare.mil/west today.

April 24, 2025

Safely Dispose of Unused Prescriptions on April 26, National Drug Take Back Day

Naval Hospital Camp Pendleton - Prescription Drop Off Form

Do not input any Protected Health Information (PHI)

Q-Anywhere is available for use by all beneficiaries. For orders placed within the last 7 days, you may use Q-Anywhere. For orders placed more than 7 days ago, please use the electronic prescription drop off form.

Don’t forget to keep your family’s information up to date in DEERS!

Email Updates

Need to Submit a Claim?

Need Technical Help?

DHA

Naval Hospital Camp Pendleton - Prescription Drop Off Form

** Do not input any Protected Health Information (PHI) **

Q-Anywhere is available for use by all beneficiaries. For orders placed within the last 7 days, you may use Q-Anywhere. For orders placed more than 7 days ago, please use the electronic prescription drop off form.

Don’t forget to keep your family’s information up to date in DEERS!

Email Updates

Need to Submit a Claim?

Need Technical Help?

DHA

Do not input any Protected Health Information (PHI)