How to Enroll into the Free Pharmacy Program:
Gather the following documents
Applications missing these documents are considered incomplete and cannot be processed until all information is received.
2. A current prescription signed by the patient’s physician. Transfers not accepted.
3. Proof of Residency: Driver’s License, Utility Bill, Phone Bill, Lease Agreement Food Stamp Letter or any government issued statement.
4. Documents supporting proof of income – the following are examples of acceptable documentation:
- A month’s worth of consecutive pay stubs dated within the last 60 days for the entire household (four pay stubs if paid weekly, two pay stubs if paid bi-weekly, etc).
- Social Security Disability “Notice of Award” letter and current year statement.
- If the patient is currently unemployed with no source of income, provide a letter of support signed by the person providing financial support and/or room and board. English Support Letter or Spanish Support Letter.Social Security Disability “Notice of Award” letter and current year statement.
- If the patient is currently unemployed with no source of income and does not have someone supporting them financially, they can complete the attached document.
5. Tax Return(s) for the current year; include Schedule C if self-employed. Patients that do not file taxes must complete the 4506-T form. Click to download the 4506T.
Mecklenburg County Residents
Residents in Mecklenburg County, can schedule an eligibility interview in the Charlotte office. Please call 704.536.1790 for more information or to schedule an appointment. We also accept walk-ins Monday-Friday 8:00AM-4:30 PM.
Residents who live outside of Mecklenburg County
Click here for a list of partner agencies in your county. Partner agencies may be able to help with the enrollment process. If you are a patient at one of these agencies, ask how you can enroll into the Free Pharmacy program to receive your medication from NC MedAssist.
How to submit applications
Fax applications to 704.536.9865
OR Mail applications to NC MedAssist, 4428 Taggart Creek Road, Suite 101, Charlotte, NC 28208