How to Apply
Applying for assistance is easy
At MCCF, we are committed to your needs—and believe that applying for assistance should not be a burden that requires a lot of time or paperwork. You have better ways to spend your time, like being with your loved ones and getting better. This is why we developed a user-friendly online application that is quick and easy to complete. It also allows for more efficient processing and reduces the use of paper, which is good for the environment.
How to apply
- To be considered for assistance, an application for our program must be fully completed. To complete your application for assistance, you will need to complete a questionnaire to determine eligibility, and provide the following documentation:
- Your most recent tax document to verify your household income
- A Statement of Medical Necessity that is completed by your physician or healthcare provider
- Health insurance coverage, whether it’s a commercial policy, Medicare, Medicaid or TriCare
To register, download and complete the application, then fax it along with supporting documents to the fax number in the blue box to the right. If you cannot download or fax the application form, call MCCF. A representative will take the information over the phone.
If you are a patient who qualifies for assistance and have found a fund that will help with your prescription please download our application form by clicking the DOWNLOAD APPLICATION button below. Print this form and fill out all information. When you have completed the application form, you may submit it and any documentation to MCCF by fax or mail.
Macaluso Compassionate Care Foundation
1A Main Street
Sparta, NJ 07871
Call 973.729.0087 with any questions.