In order to determine eligibility for the Healthy Outcomes Plan and Welvista Pharmacy, we will need the following information:
- Photo ID
- Social Security Number
- Proof of all income for all household members to include child support, SSI, food stamps, housing and utility assistance, disability, unemployment, etc.
- Proof of residency (lease or utility bill in your name).
- Most recent paystubs covering a two-week period or last year's federal tax return for everyone in the household.
- If you have applied for any of these benefits and been denied, please supply your denial statement.
- If you are receiving financial support or a place to stay, a written and signed statement by that individual describing the assistance being provided.
*Additional information may be required based upon your special circumstances*