3100 W. Central Avenue Suite 250
Toledo, Ohio 43606
Phone: 419.329.2196
Fax: 419.531.6080
Patient Services Guidelines
EMERGENCY ASSISTANCE FUND
PURPOSE: This service is intended as emergency assistance for essential medical and non-medical needs. Consideration will only be given after all other forms of assistance have been explored. Assistance is intended to supplement the cost of a particular need and not necessarily intended to cover the full cost . No financial assistance will be made for doctor or hospital bills.
GUIDELINES
Chronic Renal Failure (require dialysis or transplant to sustain life) Live or dialize within service area of the Kidney Foundation of Northwest Ohio
ESSENTIAL MEDICAL NEED
- Transportation (medical purposes only)
- Prescription Medications
- Nutritional supplements
- Medical Equipment
- Maximum assistance amount: Up to $50.00 per year.
GENERAL FINANCIAL ASSISTANCE
PURPOSE: This service is intended as temporary assistance for transportation or medication needs. Consideration will only be given after all other forms of assistance have been explored. Assistance is intended to supplement the cost of a particular need and not necessarily intended to cover the full cost. No financial assistance will be made for doctor or hospital bills.
GUIDELINES
- Chronic Renal Failure (require dialysis or transplant to sustain life)
- Live or dialize within service area of the Kidney Foundation of Northwest Ohio
- Eligibility is determined based on review of Financial Summary forms
- Income at or below 150% of Poverty Guidelines as determined by the 2010 Federal Poverty Guidelines.
Monthly Income
| Size of Family Unit | 2012 HHS Poverty Guidelines | 150% of Poverty Level |
|---|---|---|
| 1 | $ 907.50 | $ 1361.25 |
| 2 | $ 1225.83 | $ 1838.75 |
| 3 | $ 1544.16 | $ 2316.24 |
| 4 | $ 1882.50 | $ 2733.75 |
| 5 | $ 2180.83 | $ 3271.25 |
| 6 | $ 2499.16 | $ 3748.75 |
| 7 | $ 2817.50 | $ 4226.25 |
| 8 | $ 3135.83 | $ 4703.75 |
Essential Medical Need
- Transportation (medical purposes only)
- Renal Medications (approved meds only)
- Nutritional Supplements
- Medical Equipment
Patient Application Forms
This material does not constitute individual medical advice and is intended for information purposes only. Please consult with a health care professional for specific treatment recommendations.
All patients requesting assistance with medications, nutritional supplements, and/or medical equipment must get these items from the Pharmacy Counter. The Kidney Foundation is not requiring patients to switch all of their medications, etc. to the Pharmacy Counter, only the items they wish for KF to fund.
Where is the Pharmacy Counter located?
- 4143 Monroe St.., Toledo, OH, 419-474-7140
- 2701 Navarre Ave., Oregon, OH, 419-698-5408
- 2655 W. Central Ave., Toledo, OH, 419-473-1493
- 1515 S. Byrne Rd., Toledo, OH, 419-382-3475
What if it is not convenient for me to visit one of the Pharmacy Counter locations?
- Medications can be delivered to patient's home- FREE OF CHARGE
- Patient must live or dialize in Northwest Ohio area. Will go as far East as Ottawa County, as far West as Fulton county, as far South as Lima, OH area, and as far North as Southeast Michigan.
- Have drivers delivering Mon-Fri starting at 9 a.m.
- Medications can be ordered and delivered in same day.
What if I live outside of the Pharmacy Counter’s delivery area?
- Medications can also be mailed to patient's home- FREE OF CHARGE.
- Please allow 2-3 days from order date for medications to be mailed to home.
What if the Pharmacy Counter does not accept my insurance plan?
- Pharmacy Counter accepts 98% of ALL insurance plans and offers a reduced cost for prescriptions that are self-pay.
What do I do if I am a new patient to the Pharmacy Counter?
Once the form has been completed, turn it in to your social worker, Kidney Foundation, or Pharmacy Counter.
