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Credit Card Information

Credit Card
  • For most plans, the maximum allowable charge to a credit card is $500 per order.
  • Any account balance of $50.00 or more and/or more than 30 days overdue must be paid before we can ship a new order.

My Allergies

If you're allergic to a medication that isn't listed above, please call us at 866-909-5170 (TTY: 711) and we'll add it to your profile.

Optional Programs

These optional programs offer even more convenience. Select the checkbox for any or all of the options that interest you.

Designation of Authorized Party

You may designate an authorized party to act on your behalf. The authorized party can send new prescriptions or authorize refills for you.
To complete this authorization, download a form using the button to the right. Print and mail the completed form to: 7835 Freedom Ave NW, North Canton, OH 44720. Otherwise, select "Continue" to continue the registration process.
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The address information provided will be used for the family members managed within this account.
Adult dependents (age 18 and older) should register for their own web account, in which they can grant permission for the cardholder to see their information.

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