Referrals may be submitted via this form, emailed to , called in at 267-324-5347, or faxed to 267-324-5418. To download a copy of the referral form for faxing, click here.

Centennial Pharmacy Services (Independent RX Inc.) understands that this form contains highly sensitive, protective health information, and other privileged information. This form is confidential, and seen only by Centennial Pharmacy Services employees. Independent RX Inc. is a covered entity under HIPAA. By clicking submit you give Centennial Pharmacy Services permission to use the protected health information submitted.