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A Medicare
Participating Pharmacy

This program has ended, if you need COVID-19 test kits, please visit your local pharmacy.

COVID-19 Test Kits Provided by Medicare Each Month at No Cost To You

To cancel your monthly COVID-19 test kit allocation, provided by Medicare at no cost to you, please fill out the information below and we will stop sending your 8 free COVID-19 test kits each month, beginning next month if your request is received before 11:00 PM Eastern Standard Time on the last day of the month… otherwise the cancellation will take effect the following month.

Last Name(Required)
Date of Birth(Required)
Zip Code(Required)
By checking this box and submitting this request, you acknowledge that you no longer want to receive your 8 COVID-19 test kits provided by Medicare at no cost to you.

*Please note the Public Health Emergency has been extended, making these test kits available with the hopes of preventing the further spread of COVID-19. Canceling means no further test kits will be mailed to you.
This field is for validation purposes and should be left unchanged.