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Canada Drugs Phone: 1-800-226-3784 Fax: 1-800-988-5440

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CanadaDrugs.com is Canada's Largest International Mailorder Pharmacy.

Alexa ranks Canada Drugs as the #1 Canadian Prescription Service Pharmacy by volume of visitors.

Thank you for your interest in our new Medicare Savings Program! Our goal is to provide you with information that helps you save even more money while improving your coverage through the Medicare Part D program.

To help us optimize your current Medicare Part D plan, please fill out the form below. Please include all information on the medications you are currently taking.

* Required Fields

** Please enter a phone number and/or an email address. Only one is required.

Customer Name *
Phone Number **
Email Address **
Name of Part D Insurance Provider
State & Zip Code *
Month you reach the Coverage Gap *		What is the Coverage Gap? Also known as the "Donut hole" This is where your initial medication coverage stops and you start paying 100% out of pocket for your prescriptions until you reach catastrophic coverage. In 2009 this gap occurs between $2,700-$6,154.
Annual Deductible *	$	Annual Deductible If your plan does not have an Annual Deductible please enter $"0.00".
Monthly Premium *	$	Monthly Premium Your monthly payment to your private health insurance plan for Medicare Part D coverage. eg. $"25.00"

*** Please be sure to include at least one medication.

Co-pay	Medicare Covers	Do you take generics?
Co-pay Please enter your Co-pay dollar amount or percentage. eg. "$25" or "$25.00" or "25%"	Medicare Coverage Please enter your plan's Medicare coverage dollar amount. eg. $"5" or $"5.00"	Do you take generics? Please select this check box if you are currently taking a generic version of the specified medication.
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To provide a secure and safe shopping experience for all of our customers, CanadaDrugs.com is committed to meeting and exceeding all standards outlined by the leading pharmacy accreditation organizations. Click to read more...

* All prices are subject to change at any time. . For questions regarding pricing and availability of products from CanadaDrugs.com you may call 1-800-226-3784.

CanadaDrugs.com LP is presently licensed in the province of Manitoba by the Manitoba
Pharmaceutical Association. License Number 32195

CanadaDrugs.com Customer Care is located at: 24 Terracon Place, Winnipeg, Manitoba, Canada, R2J 4G7

About CanadaDrugs.com \| Site Map \| Media Center Mailing Address: 24 Terracon Place Winnipeg, Manitoba, Canada R2J 4G7 Hours of Operation: Call Centre (sales, refill and order information): 24 hours, 7 days a week Pharmacy: Monday to Friday 8:00 am to 4:30 pm Closed December 25^th and January 1^st.	Phone Numbers: Toll-Free Phone: 1-800-226-3784 International Phone: 1-204-949-1394 Hearing Impaired TTY Service: 1-877-258-7006 Fax Numbers: Toll Free Fax: 1-800-988-5440 International Fax: 1-204-224-2736
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