Student Payment Form

Secure Payment Authorization for St. Paul's Students

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Parent/Responsible Party Information

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Payment Information

This form authorizes regularly scheduled payments to be made from your credit card. Upon completion of this form, we will contact you for credit card information to keep on file for prescription copays. Proof of payment will appear on the statement you receive from your financial institution.

Allergies/Insurance Information

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If you have an International Student, please enter "SPS International"
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If you have an International Student, please enter "0"
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Downtown Concord

Ph: (603) 224-9591
Fax: (603) 224-5361
Mon-Fri 8am - 6pm
Saturday 8am - 3pm
Sunday 9am - 1pm

Concord Hospital Campus

Ph: (603) 226-4848
Fax: (603) 228-7351
Mon-Fri: 8:30am–5:30pm
Saturday: Closed
Sunday: Closed

About Us

The Prescription Center is an independent, family-owned and operated pharmacy located in Concord, New Hampshire. For over 50 years, we..
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