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-Thursday 8:30am-5:00pm
4391 Venture Drive · Peru, IL 61354

Online Refill Request

"*" indicates required fields

Required fields marked with a *

Name*

First Last

Email*

Phone*

Address*

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

Physician Information

Physician Name*

Physician Phone*

Prescription Information

Prescription Numbers*

My Refill is for:*

Pickup

Delivery

Mail

Date Needed?*

Notes of Pharmacy

Comments

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