Prescription Assistance Form
Our Prescription Assistance Program helps our patients fill monthly prescription refills at a reduced or no cost at all. To apply for our program, please complete the form below. For more information, please call (843) 416-7130 or email medicalservices@ECCOcharleston.org.
Please make sure to fill out all the required fields for this application to be submitted successfully.
Once the form is submitted, an ECCO staff member will follow up within 2 business days using the contact information you provide below.