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. 

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

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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.

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Kingwood:- (281) 312-8585 Fax 

email: mppkw@mphcc.com

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The Woodlands: (281) 298-1129 Fax 

email: mpp@mphcc.com

Download a  blank form by clicking this link

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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