Prescription Assistance Program

LOCATION:

The Annex Building 
507 Hickory Street 
Texarkana AR 71854 
Phone: 870-330-4788 

HOURS :
Tuesdays 10:00 am - 12 noon 

Many people are no longer able to afford their prescription medications. Many pharmaceutical companies offer Prescription Assistance Programs designed to help those in need obtain free or low cost prescription medications, if they qualify. Our program is designed to help people apply for these prescription  assistance programs by obtaining and filling out the appropriate forms.

The Process

Bring with you to our office at First Presbyterian Church:

1)  Completed Information Form that you will be given at your Doctor's office.  If you are unable to fill out the information, we will assist you.

2)  Proof of Eligibility (one of the following)

  • Last W-2 Form
  • Income Tax Return for last year filed (if you did not file, you will need Form #4506)
  • Determination Letter from Social Security (must be current), or Benefits Statements

3)  Prescription for ninety (90) days with three (3) refills from your doctor.  Each prescription has to be on a separate prescription blank.

  • At the Prescription Assistance Program office at First Presbyterian Church all forms will be completed.
  • The patient must return the completed forms to the prescribing physician for a signature.
  • Mail the forms with the required signature to the pharmaceutical company.
  • Your medicine will be mailed to you or to your doctor's office.

All patient information is kept confidential