Qualifications

• 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

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Required Documentation

• Copy of Prescription 

• CCF Application for Assistance

• Verification of Hardship due to COVID-19

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  Fax or e-mail required documentation to