Amendment to Performance Network Program Retail Network Enrollment FormsEffective January 1, 2017

To the extent the Provider is enrolled in the following networks, CVS Caremark® is amending the following Performance Network Program Network Enrollment Forms to reflect the amendments indicated below, effective January 1, 2017:

• Medicare Part D Retail Network 24–Performance Network Program
• Medicare Part D Retail Network 36–Performance Network Program
• Medicare Part D Retail Network 37–Performance Network Program–Preferred
• Medicare Part D Retail and Extended Days Supply Network 38–Performance Network Program
• Medicare Part D Retail and Extended Days Supply Network 39–Performance Network Program–Preferred

*Please see attached PDF for more information.