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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)

April 30, 2025

Defense Health Agency Extends Referral Approval Waiver Through June 30 for West Region TRICARE Prime Enrollees

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)