I hereby authorize Village Pharmacy to dispense medications to me and grant me access to member benefits at the rate of $180 per member per contractual year or $45 per 3 months.
This authorization to receive Village pharmacy ViP Membership or Wellness Membership services shall begin on the date I submit my payment, and shall remain in effect for the set time period selected by me. This contract may not be terminated and any or partial refund or return of funds will not be authorized after the collection of the per member fee. Village Pharmacy must provide all agreed services for the entirety of the contract. If the patient can not or chooses to not use this benefit any longer, refunds are not allowed.
I understand that my membership fee will auto-renew in either 3 months or 1 year from the date that I was originally charged unless I cancel my membership. I am responsible for ensuring my membership is canceled to prevent renewal. To do so, I will cancel on my online portal or contact the pharmacy staff.
I understand that Village Pharmacy’s ViP Membership or Wellness Membership is not an insurance plan and I may still need insurance coverage through a plan in order to have more expensive medications (like brand name or specialty medications) covered based on my specific needs and conditions. I understand that being a Village ViP or Wellness member may help lower my prescription drug costs for generic medications, but I am responsible for deciding if I need additional coverage through an insurance agency.
This contract shall be governed by and construed in accordance with the laws of the state of Tennessee.
This contract constitutes the entire agreement between me and Village Pharmacy and supersedes all prior negotiations, understandings, and agreements between the parties.
The patient’s membership may be terminated at any point by the pharmacy at the pharmacies discretion. Circumstances in which a contract may be terminated include non-payment of memberships, non-compliance with the terms of this agreement, or as the pharmacy sees fit. No refund will be permitted and no penalties or fees will be charged to the patient if this occurs.
I acknowledge that I have read and understood the terms and conditions of this contract and agree to be bound by them.