Faith Community Pharmacy

Documents needed for Program Qualification:

Applicants must live in Northern Kentucky, cannot have prescription drug coverage, and are screened to determine eligibility. Applicants with Medicare D plans are possible eligible. To participate in a screening interview, please present the following:

• 1. A picture i.d. (for example, a driver's license) and social security card.
• 2. Proof of no prescription insurance (for example, a printout from applicant's current pharmacy, or a referral from a doctor/hospital).
• 3. Verification of the income of the applicant and all members of the applicant's total household.
• 4. Verification of the rent/mortgage and heating/cooling bills.

Samples of current income for applicant and all members of the household:

1. Paycheck or pay stub bank statement

2. Dividend/interest/pension statements letter from food stamp office social security award letter proof of disability from doctor/lawyer latest tax return letter from those providing money to pay expenses

Documents needed for one-time emergency assistance:

Applicants may receive assistance with their medications on a One-Time emergency basis. In order to receive this service, they must supply the following information and return for full screening before refills are provided:

• 1. Picture i.d. (for example, a driver's license) and social security card.
• 2. Proof of no prescription insurance (for example, a printout from applicant's current pharmacy, or a referral from a doctor/hospital).
• 3. Written prescriptions.
• 4. A piece of mail proving Northern Kentucky residency.