Enroll In The Prescription Discount Program with ComCare RX

Enroll Below or Print Your Own Card from the Web site

Enrollment Information:

First Name * Middle Initial Last Name * Address 1 * Address 2 City * State * Zip Code * Telephone * E-Mail Address *

Dependent Information:

Dependent 1 Dependent 2 Dependent 3 Dependent 4 Dependent 5 Dependent 6 Dependent 7 Dependent 8 Dependent 9 Dependent 10

If you need to have a prescription filled immediately, please check the box to the left. ComCare Rx will contact you via phone or e-mail with information on filling your prescriptions immediately using the
ComCare Rx Program.

Enroll Me

Get Started Now!

Your prescription discount card is being activiated so you can use it at your local pharmacy immediately! If you would like it personalized with your name, Please provide your name and e-mail address below so we can personalize your card or click no thanks for a card without your name.

Name: Email: Submit

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