Request a Pharmacy Refill

Please complete all information below to submit and online refill. If you do not wish to complete information online, please refill your prescription by calling your Illinois CancerCare Pharmacy location:

  • Peoria (309) 243-3405
  • Bloomington (309) 243-5134
  • Galesburg (309) 243-5017

Online Refill Request

  • Required fields marked with a *
  • Physician Information

  • Prescription Information