Apply now for your Free Drug Discount Card

Our Customer Loyalty Card is open to all who do not have prescription drug benefits. There are no age restrictions, no signup fees and no membership fees.

First Name:
Last Name:
Address:
City: State: Zip:
Phone:
Email:
Date of Birth: Sex:  
Medical history
(e.g. diabetes,
asthma)
Method of payment:
Prescription Center Discount Card