Clinic Pharmacy of KY

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  • Orders will be precessed upon receipt unless otherwise requested.
  • Delivery or mail orders should be submitted before 10AM to ensure same day mailing or delivery.
Order Form
TAB key will move to next box.
ENTER key will submit the order.

Full Name:
Phone Number:
Email Address:
Pick Up, Delivery, or Mail
Prescriptions Needed: (numbers or names)
Comments, special instructions, or OTC Items

  • It's ok to include more than one person's order on this form. (e.g. a husband and wife, a parent and a child, etc.)
  • If a Mail-out or Delivery, please let us know your current address if we did not previously have it.
  • Please be sure to include your phone number and email address so we can contact you if we have any questions.

Clinic Pharmcy of KY, 141 Hospital Dr, PO Box 498, Salem, KY 42078

(270) 988-3230