Your first and last name
Your date of birth
Your phone number
Your email address
City & State
What Kohll's location would you like your prescription(s) filled at
50th & Dodge - Cris
29th & Leavenworth - Park Avenue
84th & Hascall - Westgate
127 & Q - Millard
620 N. 114th - 114th & Dodge
51st & L St
1413 S Washington - Papillion
Name of pharmacy you are transferring from
Phone number of pharmacy you are transferring from
Have you had this prescription filled by Kohll's before?
Please type the characters you see in the image in the box below exactly as you see them.
Thank-you for your submission, we look forward to working with you! One of our pharmacist will review your information and contact you within one business day to verify your prescription, insurance, and contact information.