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Medical Prescription Program
Medical Prescription Program
If you have prescriptions that your insurance doesn’t cover, or if you don’t have prescription health coverage, the Community Services Agency Medical Prescription Program can help.
Eligible households can receive up to $1000 once per program year.
Prescription must be new or refillable and non-narcotic. Call us if you have any questions or want more information.
To Qualify
This program is for Memphis and Shelby County residents whose monthly income falls at 200% at or below the Federal Poverty Income Guidelines and have prescription medication that is not covered by insurance.
To Apply
You will need:
- State Issued ID
- Social Security Cards for all household members
- Income information for household (i.e. check stubs, award letter)
- Written Prescription from doctor or refillable bottles
- Complete fillable application and print it (optional)
Complete and Print Application |
 |
Contact Information1188 Minna PlMemphis, TN 38104 901.222.4200 901.222.4242 |
HoursMonday - Friday |
Eligible Pharmacies
|
Madison Pharmacy |
The Medicine Shoppe 4770 Knight Arnold Rd Memphis, TN 38118 901-363-0750 |
This program is offered throughout the year or until funds are exhausted. Customers can submit an application by clicking on the "Download Application Form" to complete fillable application and printing. Completed application can be mailed along with all supporting documentation to 1188 Minna Pl., Memphis, TN 38104 or fax to 901-222-4240. There is also a drop box at this location.
Please take a moment to complete the Customer Satisfaction Survey
CSBG/Medical Prescription Income Guidelines for FY 2022
(EFFECTIVE October 1, 2021)
200% Federal Poverty Guidelines
| People in Household | Annual Income | Monthly Income |
|---|---|---|
| 01 | $25,760.00 | $2,146.67 |
| 02 | $34,840.00 | $2,903.33 |
| 03 | $43,920.00 | $3,660.00 |
| 04 | $53,000.00 | $4,416.67 |
| 05 | $62,080.00 | $5,173.33 |
| 06 | $71,160.00 | $5,930.00 |
| 07 | $80.240.00 | $6,686.67 |
| 08 | $89,320.00 | $7,443.33 |
| For Each Additional Person Add: | $9,080.00 | $ 756.67 |
