Registration

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Need help registering? Use these quick tips to help you get started.

ABOUT ME
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ACCOUNT INFORMATION
CONTACT METHODS
ADDRESS

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Credit Card Information

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.

End user license agreement *

*IMPORTANT: To ensure your web account aligns with all records, please make sure the information you enter below matches the information your prescriber has on file for you. This information can include, but is not limited to, the spelling of your name, any nicknames you go by, addresses, etc

ABOUT ME

CONTACT METHODS

ADDRESS