No prescription coverage, complete or partial Ineligible for Medicaid prescription coverage, complete or partial Patient's household income must be at or below current U.S. Federal poverty levels. Original prescription must be submitted. Feveral Income Tax Return must be submitted. Up to a 3 month supply will be provided at one time.
Refills require another application form and prescription.
Complete re-application is necessary on a yearly basis. The information on this website should not be used as a substitute for professional medical advice. You should contact your healthcare provider if you have any concerns or questions regarding your health condition. Information on this website should not be used to diagnose or treat a health problem or disease without consulting your healthcare provider.