2 Enterprise Drive, Suite 204 Shelton, CT 06484 T 855.693.3921
Appointment of Representative
To request a friend, relative, your doctor or other prescriber, or other person to be your representative, call Customer Care and ask for the “Appointment of Representative” form. You can also access this form on Medicare’s website.
The form gives the named person permission to act on your behalf. It must be signed by you and by the person who you would like to act on your behalf. You must give us a copy of the signed form.
Where to send: Retiree RxCare Customer Care Department 50 Whitecap Drive North Kingstown , RI 02852 Phone Number: 1-855-693-3921 Fax: 866-650-3622