In order to utilize the Substance Abuse Program you must be at least a CCS Substance Abuse member. If you are already a full member of CCS this program is included in your membership. To join as a Substance Abuse Program member click HERE. If you are unsure of your membership status please contact Paige Riley at

Card applications are processed Monday – Friday except major holidays. While we make every effort to expedite card applications, please allow 48 business hours for processing.

Special Notes: Please do not upload any tests results to the application. All test results go through your TPA. Also, please verify the spelling of the employee’s name and social security number are correct prior to submitting.

"*" indicates required fields

Contact Name*
If you have not chosen a CCS Third Party Administrator please follow this link?
Billing Address*

Mailing address for cards

CCS Cards will be mailed to this mailing address.
Same As Above
Mailing Address Contact
If different than contact name above
Mailing Address*
Name Last 6 of Social Security Number / Social Insurance Number Actions
Price: $10.00
Credit Card
American Express
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Expiration Date