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					               Alleghany CARES Medication Assistance Program
The Alleghany CARES Medication Assistance Program provides cost-free medications for qualified residents of
Alleghany County.
                                              LOCATION
                               25 Womble Street, Burgundy canopy “OFFICE”
                                            SCHEDULE
The MAP office is open each Wednesday and Thursday 11:00am to 2:00pm. New applications are taken by
appointment.
                              Documentation Needed for Eligibility
                                  1) Proof of Alleghany County Residency

                                        Valid NC Drivers License
                                                      Or
                                Current utility bill with name and address:
                                      -Home telephone bill
                                      -Electricity/heating oil other utility bill


                                    2) Proof of Income for the Household
       If you are:                                           Document(s) Needed:
      Self-employed           Schedule C, IRS Tax Form 1040
                              -if adjusted gross income is negative (self-employment lost money), then
                              Support Letter is required – see below
         Employed             Paycheck stubs/receipt: one month’s worth of stubs from the last 60 days (must
                              be dated within the past 60 days):
                                                            -if paid weekly, 4 stubs
                                                            -if paid biweekly, 2 stubs
                                                            -if paid monthly, 1 stub
 Receiving Social Security    Current year social security benefit letter
         Benefits             (can get print out from social security office)
    On Social Security        Original award letter, with start date
        Disability            Current year social security benefit letter (can get print out from social security
                              office)
  Unemployed/No Income        Most recent IRS tax return (if no return filed, need IRS form 4506-T)
                              Unemployment letter (if receiving Unemployment benefits)
                              Support letter:
                                   *Letter indicating who is providing support for day-to-day living expenses.
                                   *Can use MedAssist’s standard letter template, or create one

                                                     OVER
                                             REGISTRATION
New clients are interviewed by appointment. The following information is needed:
       *Social Security number
       *New prescriptions for each medication
               NOTE: prescriptions filled by another pharmacy CANNOT be transferred to the Medication
Assistance Program.
                                                  MEDICATIONS
Every effort is made to assist clients with their medications. We utilize the pharmaceutical companies as well
as other non-profit agencies to provide the medications freely to you.
CONTROLLED DRUGS and CHEMOTHERAPY DRUGS are not available.


                                      REFILLS OF MEDICATIONS
Clients MUST bring their empty bottles back for refills or a new prescription. We do not keep records of what
your prescription needs are at the CARES site. So you must bring your empty bottle or a written prescription
before medication can be ordered. A pick up slip must accompany local medication programs which will be
given to clients by staff.

FOR ADDITIONAL INFORMATION contact the office 372-5559 or CARES 372-5959


1-25-2011

				
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posted:9/28/2011
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