Registration

The Cleveland Clinic MyRefills Pharmacy program is only available for members of the Cleveland Clinic Employee Health Plan (EHP) prescription benefit. Eligibility in the plan includes active employees, their dependents, and retirees. If you are a Cleveland Clinic pharmacy patient, but not an EHP member, please order your prescription refill(s) by dialing 216-445-MEDS (6337).
Personal Information
Salutation:
*First Name:
*Last Name:
*Day Phone:  
Evening Phone:  
Cell Phone:  
Pager:  
Preferred Phone:
*Date of Birth:
Primary Care Physician:
(*) Required Field
Each family member needs to have their own seperate account.
Are you an employee or dependent of an employee of the Cleveland Clinic, or a member of the CC Employee Health Plan?
Allergy Information:
Please note any allergies here.
Additional Information:
Please note any special requirements here.
Insurance Information:


Preferred Shipping Address
*Street Address:
Second Line:
*City:
*State/Province
*Postal Code:
*Country:
(*) Required Field
Preferred Payment Method
Payment Type: *You MUST have the “Employee or Dependent” box checked above and your family member’s Employee ID entered in order to select Payroll Deduction as your payment method.
Card:
*Account #:
*Expiration Date:
If your card only displays a month and year, just enter the last day of that month.
Limit:
*This is the “limit” for your total order - You will be notified if your order total is above the specified limit. Setting low limit may delay shipment of your order.
(*) Required Field