Do I Qualify?

You deserve to get the medical care you need — to stay healthy, take care of your family, and live your best life. Medications prescribed by your physician are an important part of staying well — but not if you can’t afford them. The Dispensary of Hope may be able to help. It is a program that offers help to individuals who are uninsured and have limited income.

How do I qualify?

  1. You must not have any prescription coverage
  2. Bring a photo id
  3. Bring your social security card
  4. Bring any of the following as proof of income
    1. Current Tax Return, pay stubs, or bank statement
    2. SS Disability paperwork
    3. Social Security award paperwork
    4. Student loans
    5. Dated and signed letter from employer
    6. Unemployment or Pink Slip from employer
    7. Dependant Verification Form supplied by Dispensary of Hope

Gross Annual Income Gross Weekly Income
Family Size
Base + 100%
Family Size
Base + 100%
1
$23,340.00
1
$449.00
2
$31,460.00
2
$605.00
3
$39,580.00
3
$761.00
4
$47,700.00
4
$917.00
5
$55,820.00
5
$1,073.00
6
$63,940.00
6
$1,230.00
7
$72,060.00
7
$1,386.00
8
$80,180.00
8
$1,542.00
9
$88,300.00
9
$1,698.00
10
$96,420.00
10
$1,854.00

** Gross HOUSEHOLD Income is BEFORE taxes and deductions.
Patients have no charge on sample drugs.
Patients pay $3.00 per prescription for drugs on the Safety Net Drug List

What do I need to bring for continued services?

  1. You will receive a medication history card on your first visit. You must bring that at each and every visit.
  2. Proof of income

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