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Click the link above to view current income limits.
Pharmaceutical Assistance Contract for the Elderly Page
Complete and Submit your enrollment application online using the Enrollment Express Wizard! Google Chrome works best if printing a hard copy of the submitted application.
Download / View the PACE/PACENET Enrollment Form and Instructions (PDF format)
Download / View the PACE/PACENET Enrollment Form and Instructions (PDF format) in Español
Complete Coordination of Benefits form regarding Health and Prescription Insurance (PDF format). If printing documents, they can be mailed to PO Box 8806, Harrisburg, PA 17105-8806 or faxed to 888-656-0372.
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