VTE Antithrombotic Therapy Requisition - MEDICINE HAT

Pharmacare Pharmacy #5, 139 116 Carry Drive Southeast, open Mon 9am-8pm, Tues-Fri 9am-6pm, Sat-Sun 11am-2pm 

Phone: (403) 528-2111         Fax: 403-526 0655

This service is available 24 hours.  If submitting after store hours, confirm receipt of requisition by calling Dan at 403-504-9778.

Complete our online form and we will provide treatment for your patient.  All data is encrypted and highly secure.  Furthermore, we will collect identifiers when the patient contacts us.

If you prefer, you can scroll down for the pdf version which you can print, fill out, and fax to the pharmacy.

Online requisition currently unavailable
PDF Version for download
Questions? Send us a message and we'll get back to you as soon as possible.