Please find the enclosed Network Enrollment Form, effective January 1, 2019, for the following network:

• Medicare Part D Extended Days Supply Network 17

The Network Enrollment Form is included on  page two of this notification.

The Network Enrollment Form will apply to all Covered Items as indicated by a Plan’s dispensing limitations for all its plan members.

You will be enrolled effective January 1, 2019, as a provider in Medicare Part D Extended Days Supply Network 17 for the entire plan year under the terms detailed in the attached Network Enrollment Form, unless you notify CVS Caremark® in writing (via facsimile) no later than April 9, 2018, that you do not want to enroll.

CVS Caremark

Network Enrollment

FAX: 480-314-8205

*Please see attached for more information*