Claim Forms

While we provide you with a Universal Claim Form, your insurer will probably require that you submit your claim form along with their completed claim form. Insurers often request “NDC Numbers” for medications. You can find the NDC numbers for your compounded medications on the right side table near the middle of our claim form.

Medco Claim Form – Medco.pdf

IBM-Medco Claim Form – IBM-Medco.pdf

United Health Care Claim Form – United Healthcare.pdf

Still have questions or concerns?
Contact a pharmacist today for more information.