Health First Home Care
Family Pharmacy Forms

Contact Us

1350 S. Hickory Street
Melbourne, FL 32901 (map)
(In former ER area of
Holmes Regional Medical Center)

1223 Gateway Dr.
Melbourne, FL 32901 (map)

8725 N. Wickham Road, Suite 102
Melbourne, FL 32940 (map)
(Viera Hospital Medical Plaza)

P: 321-434-7355 | 866-469-1506
F: 321-434-6105

Health First Family Pharmacy Home Infusion:
P: 321-434-7373
F: 321-434-7447

Monday to Friday: 8:30 am - 6:30 pm
Saturday: 9 am - 4 pm
Sunday: Closed
Holidays open: 9 am to 4 pm on Memorial Day, Labor Day and July 4
Holidays closed: New Years Day, Thanksgiving and Christmas Day

Health First Family Pharmacy Forms

Order here. When filling out the Online Form, please be sure to fill out the Member Information and Payment Options sections with each order. The Health History section is only required for your first order or as information changes. Please complete the other sections of the form as applicable.

If you need to order new prescriptions, refill current prescriptions, or transfer prescriptions from another pharmacy, please fill out the pdf and either fax (321-434-6105) or mail the printed form to 1350 S. Hickory Street, Melbourne, FL 32901.

  • Order Form - For New Prescriptions, Refills, or Transferring prescriptions from another pharmacy


Health First Family Pharmacy

Filling out prescriptions to help you.