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Life Sustaining Medication Assistance


  • Must Demonstrate Hardship Due to COVID-19 (letter from former employer, medical bills, letter from unemployment office, etc.)

  • Must be a current Sapulpa Resident

  • Prescription must be in applicant's name and address

Required Documentation

  • Copy of Prescription 

  • CCF Application for Assistance

  • Verification of Hardship due to COVID-19

  Fax or e-mail required documentation to


Fax: 918-224-6436

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