Part D Information Name* First Last ZIP Code*Your Favorite PharmacyAnother Pharmacy for BackupAny pharmacy you won't use?I need your new Medicare ID number!*Your Medicare ID is 11 characters and numbers. It should not include your Social Security number! (The government changed this.) Drugs You're TakingDrug NameDrug DosageHow Often is Drug Taken?Is the Generic Version Okay?Add drugRemove drugMaximum of 12 drugs
