The Pharmacare form and worksheet below are available for download as PDF documents, for your convenience.
Completed forms and worksheets, and any supporting documentation if required, can be submitted by fax or mail to the address below.
For more information, please contact:
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