Village Pharmacy



Phone: 678-501-5165 | Toll Free: 877-822-4901 | Fax: 678-501-5170


3697 Hwy 5 Ste, 6 Douglasville, GA 30135

Mon - Fri: 9 - 6:30, Sat: 9 - 2, Sun: - Closed

Insurance Claim Forms

Compounded prescription medicines are covered by many major insurance plans. In many cases, Village Pharmacy can submit a claim for compounded medicines that are covered by your plan. If not, we can help you complete a request for reimbursement.

Follow the steps below to submit a reimbursement request to your insurance plan.

  1. When you pick up your compounded medicine, Village Pharmacy will give you a form to send in to your insurance carrier. Our form is approved by the International Academy of Compounding Pharmacists.
  2. Prior to submitting the form, contact your insurance carrier’s customer service department. They may require their own form in addition to the compounded medicine form that Village Pharmacy provides.
  3. Fill in your personal information on required form(s). Mail the completed form, along with your paid receipt (and insurance claim form if required), to your prescription insurance carrier.