If you or someone you know is struggling to afford medication please contact your healthcare provider and ask them to send us a completed referral form along with your prescriptions. Once that is received our office will contact you.

Identification

  • Photo ID

Proof of Residence

  • A piece of mail that includes your current physical address in one of the following 14 counties: Boone, Bracken, Campbell, Carroll, Fleming, Gallatin, Grant, Harrison, Kenton, Lewis, Mason, Owen, Pendleton, or Robertson.

Proof of Household Income For Each Member of the Household

  • Tax Returns
  • Pay Stubs / Unemployment
  • Social Security Award Letter
  • Pension Statements
  • Food Stamp Letter if Zero Income

Proof of Insurance Status

  • Current Prescription Insurance Card
Service Region Map