COVID-19 Prescription Delivery Form

Effective April 1, 2020, the Happy Valley Police will pick up life preserving prescription medication and deliver to private residences within Happy Valley, from pharmacies located within the City’s boundaries. This program will be effective for the duration of the governor’s Executive Order, currently set to expire on April 28, 2020. Unsure if your location is in Happy Valley? You can check your location by clicking the map link below.
City Boundary Map
Resident Information
Name
First Last
Delivery Street Address ZIP Code
Phone
Email

You do not need an email address to request delivery.
Prescription Information
To help us get the prescriptions to you efficiently we ask you to:*
- Select All
- Contact your local Pharmacy and order the prescription.
- Pre-pay for the prescription over the phone.
- Advise the pharmacy that the Happy Valley Police Department will be picking up the prescription.
- Have valid identification available when the officer arrives at your residence.
Pharmacy Name*
Prescription name. For multiple prescriptions, you may click the + button to add more lines.
Number of prescriptions to be delivered*
Additional Information
Please list any additional information we should be aware of

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