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  • Silverscript Appointment Of Representative Form

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Form Approved OMB No.0938-0950 APPOINTMENT OF REPRESENTATIVE FOR SILVERSCRIPT INSURANCE NAME OF PARTY MEDICARE OR NATIONAL PROVIDER IDENTIFIER NUMBER SECTION I: APPOINTMENT OF REPRESENTATIVE To be.

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To appoint a representative, you or your representative should complete the form entitled: Appointment of Representative - CMS-1696 - PDF.

Aetna®, CVS® and SilverScript® are part of the CVS Health® family of companies.

Please contact SilverScript Insurance Company at 1-888-648-9626, 24 hours a day, 7 days a week (TTY users call 711).

Call SilverScript Customer care toll free at 1-866-634-6558, 24 hours a day, 7 days a week. TTY users call 1-866-236-1069.

SilverScript is now part of Aetna Medicare Pay your premium. Check drug coverage. Locate a pharmacy.

Aetna is owned by CVS Health, so a SilverScript plan may be used at any CVS pharmacy. CVS is a preferred in-network pharmacy. Walgreens is a standard in-network pharmacy.

Appointment of Authorized Representative (Purpose: To grant permission for another individual or company to act on your behalf in filing a Grievance or Appeal).

About SilverScript A proud member of the CVS Caremark Health family of companies, SilverScript Prescription Drug Plan serves more than 5 million members and has become one of the largest Medicare-approved Part D prescription drug plan providers.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232