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We sincerely appreciate your business!

King Pharmacy is in complete compliance with Federal and HIPAA legislation designed to protect patients privacy rights. 

Please fill out the form below to be added to our customer list.

Participant ID/ Rx Prescription Card Holder ID

Date Of Birth

First Name (Enter your Legal First Name)

Last Name



Relationship to Card Holder

Primary Card Holder Last Name (Complete this field if the last Name on your Prescription Benefit Card is Different)

Group Code (If Available, complete this field to speed up the registration process)

Recent Prescription number (This should be a prescription ordered under the plan that you are registering )

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