IMPORTANT: All documents are REQUIRED to be considered for assistance. If you do not have a document, please provide an explanation.
Please ensure that all files are clear and legible before uploading. Illegible documents will delay your application process.
You must not have current health insurance to be eligible for RX assistance.
Example: Electricity is included in my rental agreement.
Example: Water is included in my rental agreement.
Example: Gas is included in my rental agreement.
Example: I rent an apartment.
Example: I own my home.
Example: I live in a zero income household.
Example: There is no bank account in my household.
Please be aware that once all the correct documents have been submitted, you will be called to set up an a meeting with a Case Manager. At the time of the meeting, the Case Manager will determine the type and amount of financial assistance we will be able to assist with, if found eligible.
It is important to note, that financial assistance is not always guaranteed, however, you may be offered other types of non-financial assistance or resources instead.