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Patient Financial Assistance

Let us help you find out if you qualify for financial assistance programs from drug manufacturers and non-profit organizations. We can help you fill out the application. 

Download the form to your computer.  Either fax or scan the form to your pharmacy location. 

* * To save time please have proof of income (either last year’s tax return or Social Security Benefits letter) attached to this form.  

Please note: Most financial assistance awards are based on income. There is no guarantee that you will receive assistance. It normally takes 3-5 business days to get an answer.


Please call the pharmacy if you have questions.

Kingwood:- (281) 312-8585 Fax 


The Woodlands: (281) 298-1129 Fax 


Or Just fill out this contact form and someone from Millennium Pharmacy will contact you soon.

For more information on Financial Assistance

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