DSC Risk Sevices I Risk Management

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

email: mppkw@mphcc.com

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