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TheraCys Patient Assistance Program
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C/O NORD
PO Box 1968
Danbury, CT 06813-1968
Phone
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877-798-8716
Fax:
Not Applicable
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Eligibility
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This program is based on guidelines that are not disclosed. The patient is given assistance from 25%-100% for one year. A negative decision can be appealed.The patient must also be a US citizen being treated by a US doctor. |
| Who Can Apply
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With the patient's permission, anyone concerned can call for an application. |
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Required
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The doctor must fill out a section, sign the application and attach a prescription.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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Ship To
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Doctor's office |
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Note
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With the patient's permission, anyone concerned can call for an application. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| TheraCys BCG Live (Bacillus Calmette; Guerin) |
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Menomune Patient Assistance Program
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Menomune Patient Assistance Program
C/O NORD
Danbury, CT 06813-1968
Phone
:
877-798-8716
Fax:
203-798-2964
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Eligibility
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The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. The patient is given assistance from 25%-100% for one year. A negative decision can be appealed.The patient must also be a US resident. |
| Who Can Apply
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Anyone with the patient's and the doctor's information can call. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income and any insurance information. |
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Supply
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Ship To
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Doctor's office |
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Note
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Anyone with the patient's and the doctor's information can call. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Menomune A/C/Y/W-135 (meningococcal polysaccharide vaccine) |
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Imogam and ImoVax Patient Assistance Program
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C/O NORD
PO Box 1968
Danbury, CT 06813-1968
Phone
:
877-798-8716
Fax:
203-798-2964
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Eligibility
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The patient must have no prescription coverage for the requested medication and have a low income based on the Federal Poverty Guidelines. The patient must also be a US resident. |
| Who Can Apply
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The doctor/doctor's office must call for a prescreening. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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Ship To
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Doctor's office |
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Note
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The doctor/doctor's office must call for a prescreening. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Imogam |
| Imovax Rabies IM (Rabies Vaccine) |
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