PATIENT NAME: ADDRESS : Discount D Rush Foun dation Hos rug Progra pital and th (SunRx 340 e local phar B program) m macies liste that helps p d belo at Instruction s: ü Take your resources to w participa ients save m te in a prog o n e y o strengthen n their me ram health care dications a in our com n d provides munity. prescriptio n to one of up to 60% our pharm off the cost acy partne of your fam bottom of t rs. At the p ily’s medica his sheet. harmacy, yo tions. Our u can save pharmacy p How much artners are can I save? listed at the ü Your savin gs will vary on each pre can save up scription. P to 60% off atients wit t h e c o hout healt st of medic If I have in h insuranc a tions. surance co e coverage verage, can ü If your med I still bene ications are fit? covered by Although y your policy our costs w , you will p ill not chan makes the ay your co ge, your pa program st pay as you rticipation ronger for usually do with our p all who pa ü If your me . harmacy p rticipate. dications ar a r t n e r s e not cover of your pre ed by your scription u insurance, p to 60%. this progra Are all med m can redu ications co ce the cost v ered? ü Most comm only prescr ibed drugs are include d in this pr Rush Foun ogram. dation Wal-Mart 1 0-1271 2400 Highw ay Meridian, M 19 North S 39307 Wal-Mart 1 0-0981 1733 2nd S treet Meridian, M South S 39301 (Bonita) Wal-Mart 1 0-0205 1002 Beaco n St. Philadelphia , MS 39350 DATE: Hospital/S un Wal-Mart 1 0-1069 231 Eastsid e Dr. Newton, M S 39345 CVS Pharm acy #05825 82 0 Highway 19 North, S te. 195 Meridian, M S 39307 CVS Pharm acy #05835 24 01 North H il Meridian, M ls St. S 39305 CVS/Pharm a cy #05846 822 Highw ay 35 North Forest, MS 39074 SIGNATU RE: Rx 340B P harmacy P artners Wal-M art 10-785 1350 Azale a Dr. Waynesboro , MS 39367 Wal-Mart 1 0-1 059 1309 Highw ay 35 South Forest, MS 39074 Wal-Mart 1 0-0 183 159 Highw ay 25/15 So uth Louisville, M S 39339 Winn-Dixie 5 5100 Highw 33 ay Meridian, M 39 North S 39301 The Pharm ac y at Rush 1800 12th Street Meridian, M S 39301 Winn-Dixie 4 2014 Highw 72 ay Meridian, M 45 North S 39301 10/13/201 4