Add Prescription - Healthville Pharmacy

Provide Your Prescription

Please Fill Your Prescription Below

Steps to Get Started

Contact your prescriber.
Upload your prescription below.
Within 24 hours, we’ll match the prescription to your account and notify you by email.
Once your prescription is verified you will be notified to make a payment.
We will process your prescription and it will be delivered to you.

Ask your doctor to write a new prescription that includes ALL of the following information:

Your name
Your email address
Your date of birth
Your medications

Give your doctor this information for our pharmacy

NCPDP ID # 5919925 Tel: 1-866-340-1413

Prescription Form

Prescription (Patient Dashboard)

First Name

Last Name

Medication Type

Confirm Medication Name

Note: can't find your medication? Click here

Compounding Medication

Drug Price (30 Count)

Drug Price (90 Count)

Drug Price (100 Count)

Drug Price (200 Count)

Compounding Drug Price (30 Count)

Compounding Drug Price (90 Count)

Compounding Drug Price (100 Count)

Compounding Drug Price (200 Count)

Confirm Drug Count Selected Above

Total Cost

Submit button will be Disabled if Total cost is zero or empty. Kindly select a medication, and drug price.

Do you have a prescription?

Prescription

Maximum file size: 10MB

Please contact your Doctor for prescription

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Billing Address

Address Line 1

Address Line 2 (Optional)

City

State/Province

Zip/Postal

Shipping Address

Same as billing address

Add new shipping address

Shipping Address

Address Line 1

Address Line 2 (Optional)

City

State/Province

Zip/Postal

Credit Card

Card Number

Month

Year

CVC