Those Who Do Not Qualify:
Patients with prescription insurance, Medicare or Medicaid patients, members of a
FQCHC such as Peak Vista, children under 18 years old and veterans with benefits.
Patients MUST meet ALL of the following requirements in order to be served by TLC Pharmacy!
1. Be between 18-64 years of age
2. Have an income Level at 200% or less of the Federal Poverty Guidelines (See Below)
3. Have no health insurance coverage, and not be eligible for state or federal care
4. Not be a member of a Federally Qualified Community Health Care Center (Peak Vista)
5. Pay the non-refundable registration fee (CASH ONLY) of $15.00 per individual or $25.00 per family for a one year enrollment period.
6. (If residing in a Community Correctional Facility or Halfway House such as ComCor, CAE or Liza’s Place) you must provide a letter (on the facilities letterhead) from your case manager stating: When you arrived at the facility? How long you will be residing at the facility? Employment status, any income information and how much is being charged for room and board?
7. Call TLC Pharmacy at (719) 596-4449 to schedule an appointment for eligibility and intake.
Documents Needed to Become Eligible:
1. Photo Identification
2. Proof of Residency in El Paso or Teller Counties
· Lease or Utility Bill
3. Proof of HOUSEHOLD Income – This can be accomplished by providing to us any of the following:
· Income Tax Forms / W-2 for the previous year
· Pay Stubs for the previous 2 months
· Unemployment Compensation Voucher
· Disability letter from the Social Security Administration
· Bank Statements showing automatic deposits for the previous 2 months
· Food Stamps letter showing income
|2012 Poverty Guidelines|