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Last Page
First Name
Patients First Name
Address Line 1
City
Postal Code
Surname
Patient Surname
Address Line 2
Province
Medical Aid Details
Medical Aid *
Medical Aid Name *
Email address of medical aid (chronic submissions)
the email address for chronic submissions
Medical Aid Plan
Medical Aid Number
Dependant Number
Prescribing Doctor
Dr Practice Number
Supporting Documents

Should you have a prescription from your doctor or any additional supporting documentation that you would like to attach to this submission, you can upload it here. (Note that uploaded documents should not exceed 1MB in size and can only include the following types: PDF / JPEG / JPG

supportingDocs
Maximum file size: 1 MB

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The CDE Pharmacy (Pty) Ltd
T/A The Centre Pharmacy

Pharmacy Nr: Y03847
81 Central Street, Houghton Estate
P.O.Box 2900, Saxonwold, 2132, South Africa
Tel: +27117126000
Fax: +27117286661

Responsible Pharmacist: Imraan Ahmed Bismilla
(P00935)