Needed Documentation

In order to determine eligibility for the Healthy Outcomes Plan and Welvista Pharmacy, we will need the following information:

1. Photo ID
2. Social Security Number
3. Proof of all income for all household members to include child support, SSI, food stamps, housing and utility assistance, disability, unemployment, etc.
4. Proof of residency (lease or utility bill in your name).
5. Most recent paystubs covering a two-week period or last year's federal tax return for everyone in the household.
6. If you have applied for any of these benefits and been denied, please supply your denial statement.
7. 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*