Health, Seniors and Active Living
Pharmacare Forms and Worksheets
The Pharmacare form and worksheet below are available for download as PDF documents, for your convenience.
- The Pharmacare Application and Consent Authorization Form
- The 2017/2018 Pharmacare Benefit Year Projected Income Worksheet
Completed forms and worksheets, and any supporting documentation if required, can be submitted by fax or mail to the address below.
|Manitoba Health, Seniors and Active Living
Provincial Drug Programs
300 Carlton Street
Winnipeg, Manitoba R3B 3M9
Toll free: 1-800-297-8099
TTY/TDD Relay Service: 204-774-8618 outside Winnipeg: 711 or 1-800-855-0511