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.
Blue Cross Blue Shield/Medco
Merck-Medco Claim Form
IBM-Medco Claim Form
United Health Care Claim Form