Get started by enrolling your office

Fill out the form below and click "submit" when you finish. When your enrollment is complete, call 866-264-2778 to submit your merchant ID and register the credit card terminal you will be using to process AVSOLA® Co-Pay Cards. All fields are required.

Office enrollment

Have questions about this form? Call the AVSOLA® Co-Pay Program at 866-264-2778 for assistance.

The AVSOLA® Co-Pay Program Prepaid MasterCard® is issued by Comerica Bank pursuant to license by MasterCard International Incorporated. No cash or ATM access. MasterCard is a registered trademark of MasterCard International Incorporated. This card can be used only to cover co-payment for eligible prescriptions covered under the program at participating merchant locations where Debit MasterCard is accepted.