​                                                 *Exclusions May Apply*
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Writing a Compound Rx
Our compounding pharmacists will be happy to discuss formulations and answer any questions. 
Call at 408-227-1098 or toll free at 844-448-2291

    Rx   __________________________

    Compounded Medication*

    Generic Name of Active Ingredients / Strength or Dose    (i.e., mg or %)

    Dosage Form      (i.e., Suppository, Transdermal Gel, Troche)


    Directions for Use
*Prescription should begin with the phrase "Compounded Medication".


              Safeway Compounding Pharmacy                    San Jose, Ca  (p):408-227-1098; (f):408-227-1206; Toll Free: 844-448-2291                          

                                                                            © Copyright 2013 Safeway Compounding Pharmacy. All rights reserved. 
Safeway Compounding Pharmacy only dispenses and ships prescription drugs to the following states in which they are licensed to practice:  CA, CO, HI, IL, MO, NV, RI, UT, WA WI, WY. Safeway Compounding Pharmacy does not currently dispense or ship prescription drugs to any other states. 
Safeway Compounding Pharmacy only compounds and dispenses prescription drug products to patients upon receipt of a valid, patient-specific prescription.