Your first and last name *
Your date of birth choose date *
Your phone number *
Your email address *
Street address *
City & State *
Zipcode *
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
Drug name
Prescription number
Have you had this prescription filled by Kohll's before? Yes No
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.
Transfer a prescription
