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If you’re a patient, we’re here to help you fill prescriptions or provide you with the information you need to work with your doctor to help decide if a compounded prescription might be a good treatment for you.
Prescribers, for additional information on our compounded therapies, including pricing, fill out the form below.

    New PatientCurrent PatientCurrent Custom Rx Pharmacy PrescriberNew Custom Rx Pharmacy Prescriber
    Please choose one.


    Clinic State*

    How would you like us to contact you?*

    How many patients do you see monthly?*

    Your Title?*

    What are you interested in?*:
    Hormone TherapyNon-Sterile MedicationsSterile MedicationsTopical Numbing Creams

    Do you have a prescription to submit today?*:

    When would you like to start prescribing?*

    How did you hear about us?*

    How can we help you?*

    To protect your privacy, please do not provide information personal to your medical history or medication you currently take.

    By providing your email address you agree to receive promotional emails from Custom Rx Pharmacy.

    • Custom Rx

      3510 N Ridge Rd, Ste. 900
      Wichita, KS 67205

      Ph: 316-721-2626
      Fax: 316-721-4823

      Toll-Free Phone: 855-287-6879
      Toll-Free Fax: 855-721-4823

    • Hours

      Monday-Friday: 9am to 6pm