Thanksgiving Hours: Wednesday, 11/27 - 8am to 12pm; Thursday, 11/28 - Closed; Friday, 11/29 - 8am to 12pm

First American & Non-First American Spouse Prescription Program

To avoid any delays, please only send prescription requests once you have received approval of your application. Additionally, we kindly ask that you wait at least four business days after submitting your application before making any prescription requests.

Apply by Mail

Please submit completed forms and all documentation to the Chickasaw Nation Pharmacy Refill Center.

1. Eligibility Form

The following form is required to verify eligibility for the program. Download, complete and return the form to the Chickasaw Nation Refill Center.

Download the Application

2. Notice of Privacy Practices (NOPP)

The Notice of Privacy Practices for the Chickasaw Nation Refill Center is a printable advisory for patients that explains the terms of use of patient-protected health information. This form is intended for patient use only and does not need to be returned to the pharmacy.

Read the NOPP

3. Acknowledgement of Receipt

The Acknowledgement of Receipt of Notice of Privacy Practices Form must be signed and returned to the pharmacy before any patient can be eligible to receive medications.

Sign the Acknowledgment

4. Provide Required Identification

All participants must submit copies of the following documentation:

Certificate of Degree of Indian Blood (CDIB) (if applicable)
Tribal citizenship card (if applicable)
Prescription insurance card, front and back
Secondary prescription insurance card, front and back (if applicable)
Marriage license (if applying as a non-Native spouse)
DL/state ID (Participants under 18 years of age need to have a parent or legal guardian’s valid ID on file)

Request Medications

Once your application is approved, submit your prescriptions to the Chickasaw Nation Refill Center for processing. Approved medications are provided to patients at no cost. When it’s time to refill your medications, you may use any of the convenient options listed below:

Web Refill Patient Portal
RefillPro smartphone application (iOS/Android)
Call the pharmacy toll-free at 1 (855) 478-8725

Prescription Program Eligibility Information

All program participants require approval before receiving prescription assistance and requesting medications through the Chickasaw Nation Refill Center.

First Americans:

Prescription drug assistance for First Americans and non-First American spouses with active private or Medicare Part D prescription insurance is available through the Chickasaw Nation Refill Center (federally recognized tribes only). For enrollment approval, prescription insurance coverage is required. Prescriptions are subject to insurance approval and will be made available by mail or pick-up at the Chickasaw Nation Refill Center.

Once enrolled, participants may have prescriptions sent to the Chickasaw Nation Refill Center to be reviewed and processed. Completed prescriptions will be available to patients via mail or to be picked up in the drive-thru at the Chickasaw Nation Refill Center. As refills are needed, participants may call the Chickasaw Nation Refill Center directly or utilize our website, email, smartphone application or interactive telephone service to process refill requests.

All Participants Must Provide:

Completed Application (each participant must submit a separate application)
Copy of CDIB Card
Copy of Tribal Citizenship Card
Copy of Prescription Insurance Card (front and back of insurance card)
Signed Acknowledgement of Receipt of Notice of Privacy Practices form

Non-First American Spouses:

Non-First American spouses must submit a current marriage license with the application in addition to the required documentation listed on the enrollment application.

All Participants Must Provide:

Completed Application (each participant must submit a separate application)
Copy of CDIB Card
Copy of Tribal Citizenship Card
Copy of Prescription Insurance Card (front and back of insurance card)
Copy of Marriage License
Signed Acknowledgement of Receipt of Notice of Privacy Practices form

Chickasaw Citizens Under 19 Years of Age:

Uninsured Chickasaw citizens younger than 19 years of age living outside of the Chickasaw Nation boundaries may contact the Chickasaw Nation Refill Center for alternative eligibility requirements for prescription assistance.

All Participants Must Provide:

Completed Application (each participant must submit a separate application)
Copy of CDIB Card
Copy of Tribal Citizenship Card
Copy of Prescription Insurance Card (front and back of insurance card)
Signed Acknowledgement of Receipt of Notice of Privacy Practices form

Non-Covered Items Include:

Investigational Drugs
IV medications and IV drug administration devices not covered by your insurance plan
Over-the-counter (OTC) medications not covered by your insurance plan
Compounded medications

All controlled substance medications must be picked up at the Chickasaw Nation Refill Center.

933 N. Country Club Road
Ada, OK 74820

Toll-Free: 1 (855) 478-8725

Local: (580) 421-8725

Fax: (580) 421-8701

Email: CNRefillCenter@Chickasaw.net

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