| |
Program Details
RXOUTREACH
Rx OUTREACH - Diabetic Supplies
Prodigy No Coding Blood Glucose Strips
(blood glucose strips)
|
| CONTACT
INFO |
|
| Address: |
PO Box 66536
St. Louis, MO 63166-6536 |
| Phone: |
1-800-769-3880 |
Provider Phone: |
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| Fax: |
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Website: |
Program Website |
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| ELIGIBILITY
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|
| Eligibility
Info: |
An individual of any age can participate in the program, as long as the program's financial guidelines are met.
|
| Income at or below: |
Single |
$32,490 |
300
% FPL |
| |
Couple |
$43,710 |
300
% FPL |
| Federal Poverty Level Calculator |
 |
| |
Credit for Dependents allowed |
| Other Income
Requirements: |
$54,930 for family of 3
$66,150 for family of 4
Add $11,220 for each additional person |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security requested on form: |
Yes |
| US citizenship/residency specified:
|
Not
Published |
|
|
APPLICATION |
|
| Attachments
Required: |
Financial
Also include check, money order or credit card information.
|
Physician
License #
Required: |
Not Required
|
Prescriber
Signature
Allowed: |
Only patient needs to sign the application. |
Application
may be
faxed: |
No |
Eligibility
determination
letter sent: |
None
|
|
| MEDICATION |
|
| Receives: |
Medication
|
| Shipped To: |
Provider
Products sent to wherever the patient requests it.
|
| Quantity in
Shipment: |
Prodigy Preferred Blood Glucose Monitor - 1 free per year
Strips - $15 for a box of 50 = minimum order 2 boxes for $30
Lancets 28G - $5 for a box of 100 = minimum order of 2 boxes for $10 |
| Delivery Time: |
0-1 week
|
| Re-application
Policy: |
New application every 12 months
|
| Refill Policy: |
|
| Other Information: |
A separate application must be submitted for each household member applying for medication. |
|
|
Last Updated: 05/08/2023
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Application Forms
& Instructions
The following documents
are provided in interactive PDF format, allowing you to type information
directly into the form.
 Form (English)
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