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All fields except for the Prescription Number are required. For more information about a particular field, click the ? box to the right.

First Name	:	? A value is required. Exceeded maximum number of characters.
Last Name	:	? A value is required. Exceeded maximum number of characters.
Member Id	:	? A value is required. Exceeded maximum number of characters. Numbers/letters only
Group Id	:	? A value is required. Exceeded maximum number of characters.
Date of Birth	:	? A value is required. Should be Ex:mm/dd/yyyy. Example: 04/05/1982
Prescription Number	:	? Numbers Only Exceeded maximum number of characters.
Email Address	:	? A value is required. Please enter valid email
Phone	:	? Please enter phone. US Phone(Ex:(000) 000-0000) Example: (800) 555-1212
Coverage Date	:	? A value is required. Should be Ex:mm/dd/yyyy. Example: 04/23/2024
User ID	:	? A value is required. Minimum number of characters not met. Exceeded maximum number of characters Numbers/letters only
Password	:	? A value is required. Minimum number of characters not met. Exceeded maximum number of characters Example: blue*light24
Verify Password	:	? A value is required. Minimum number of characters not met. Exceeded maximum number of characters. Retype password

Access to this site is restricted to Script Care members to make the best use their Script Care benefits. All other access is prohibited.

By creating this account, you agree to the following:

1. That the name, date of birth and subscriber number are yours or belong to an individual for whom you have legal access to his or her pharmacy benefit information.
2. You understand that access to this site is monitored and logged and that unauthorized access will be prosecuted to the full extent of the law.
3. The email address and phone number you provide are yours, are valid and can be used to contact you to resolve issues with this account. For example, if you need to reset your password, we will email the new password to the email address you provide. This information will not be provided to third parties for marketing purposes.