Request a Pharmacy Refill - Illinois CancerCare

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
Hours: Monday-Friday 8:00am-5:00pm
Located in the Peoria Cancer Center, on the first floor, behind the main staircase
Bloomington – 309.243.3018
Hours: Monday-Friday 8:30am-5:00pm
3105 Magory Drive · Bloomington, IL 61704
Galesburg – 309.243.3017
Hours: Monday-Friday 8:30am-5:00pm
336 Home Boulevard · Galesburg, IL 61401
Pekin – 309.243.3014
Hours: Monday-Thursday 8:30am-5:00pm
1641 Broadway Street · Pekin, IL 61554
Peru – 309.243.3019
Hours: Monday-Friday 8:30am-5:00pm
4391 Venture Drive · Peru, IL 61354
Washington – 309.243.3016
Hours: Monday-Friday 8:30am-5:00pm
110 Eastgate Drive · Washington, IL 61571
Macomb – 309.243.3012
Hours: Monday, Tuesday, Thursday 8:30am-5:00pm
CLOSED WEDNESDAY AND FRIDAY
501 E. Grant Street · Macomb, IL 61455
Ottawa – 309.243.3013
Hours: Monday, Tuesday, Thursday and Friday 8:30am-5:00pm
CLOSED WEDNESDAY
1200 Starfire Drive · Ottawa, IL 61350

Online Refill Request

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Name*

First Last

Email*

Phone*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Physician Information

Physician Name*

First Last

Physician Phone*

Prescription Information

Prescription Numbers*

My Refill is for:*

Pickup

Delivery

Mail

Date Needed*

Notes to Pharmacy