Please complete steps 1-4 to register for a retail opportunity. To finalize your submission, you must click SUBMIT during STEP 4.
You must also complete and fax the necessary deposit authorization, if applicable, to (817) 410-5999.
Agents without a deposit on file, and who choose an opportunity that requires one, will not have the opportunity to bid on locations each summer, prior to MAPD Sales Season. When bidding is over, the agent will not be able to participate in the current year opportunities.
IT IS IMPORTANT TO REGISTER AND SUBMIT YOUR DEPOSIT EARLY, TO ENSURE THE ABILITY TO OBTAIN A LOCATION.
Walmart KioskCVS KioskBothOther
Walmart Program InformationThe Walmart Retail Program spans MA and ACA selling seasons. The program requires a $500 up-front refundable deposit, per store, before any store bidding will occur. Download the PDF credit card authorization form HERE.
CVS/Silverscript Program InformationSilverscript Part D is a stand-alone PDP through CVS Caremark
Other ProgramsOther retail opportunities include the Aetna store program, operating in stores such as Rite-Aid, Walgreens, Safeway, Kroger, Albertsons, and more. It is like the Walmart and CVS programs, but is sponsored by Aetna.
List 3 locations you will accept, beginning with your most desired, followed by your second and third choice.
Please verify that all the information you have entered is correct.Then click the Submit button to send us your registration.
By submitting this registration you agree that you will: Fax the completed credit card authorization to (817) 410-5999, andGet contracted, through Empower Brokerage, for at least 3 of the primary MA and PD carriers for your area, within 72 hours.The only exceptions will allowed in areas that have one or two total MAPD plans available.
Walmart Kiosk Participants must pay a $500 Deposit via THIS FORM, before stores can be granted.
Credit Card Deposit Form
***Payment Options Are Available***