Agent CVS Form

    ***IMPORTANT***

    In order to participate in the CVS SilverScript Kiosk Program, during this year’s OEP, you must be contracted with SilverScript through Empower and you must have your AHIP certification up to date.

    To register with Empower and request appointment with SilverScript, CLICK HERE NOW!

    Your FULL Name (required)

    Your Phone (required)

    Your Email (required)

    Your Subject

    Please list, below, your ideal location and a few backup choices. (full addresses only)

    I understand that I must be contracted with SilverScript, through Empower Brokerage, in order to participate in the CVS Retail Opportunity

    Please list your SilverScript writing number