Grand Valley Health Plan - Choose Well
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Running short on medication and want a convenient way to request a prescription refill? Grand Valley Health Plan is pleased to announce that plan members can now place refills requests online, using a convenient refill form.

DISCLAIMER: Please note that the following terms and conditions of use apply to online prescription refill requests:
  • This service is intended only for prescriptions filled at Grand Valley Health Plan pharmacies.
  • In order to request a refill you must have either your 8 digit prescription number or must have the name of the medication in question.
  • We cannot process your request unless you complete the refill form in its entirety, including your name and a contact phone number you can be reached at.
  • If you have refills available on your prescription, your medication will be ready for pick-up in 24 hours.
  • If you do not have refills available, your medication will be ready for pick-up in 48 hours.
  • Prescription mail-outs are available only if a method of payment is on record at your pharmacy. Prescriptions will only be mailed to your address of record.
  • Prescription information transmitted to and from the GVHP website is encrypted for your protection. However, the security of information transmitted through the Internet can never be guaranteed. Please take adequate steps to ensure that your information does not fall into the wrong hands.
I understand and agree to these terms.

Prescription Refill Request Form
Personal Information
Your Name:
Contact Phone #
Family Practice:
Prescription Information
Prescription # OR Medication Name
Re-enter Prescription #
Pick-up At: