| |
Bradley Pharmaceuticals Patient Assistance Program
|
383 Route 3 West
Fairfield, NJ 07004
Phone
:
(800) 929-9300
Ext 584
Fax:
|
|
Eligibility
|
| > |
Eligibility is based on income and lack of third party prescription coverage. |
| Who Can Apply
|
| > |
Application information is taken over the phone. |
|
Required
|
| > |
Caller must provide complete physician information (including DEA, State License, phone and fax numbers) as well as complete patient information. |
|
Supply
|
| > |
90 days. |
|
Ship To
|
| > |
Physician's office. |
|
Note
|
| > |
|
| |
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.
|
| Anamantle HC (lidocaine HCl & hydrocortisone acetate) |
| Carmol 40 Cream (40% urea) |
| Carmol 40 Gel (40% urea) |
| Carmol 40 Lotion (40% urea) |
| Carmol HC (hydrocortisone acetate, USP) |
| Carmol Lotion (10% sulfacetamide sodium, USP) |
| Deconamine (chlopheniramine maleate & pseudphedrine HCl) |
| Deconamine SR (chlopheniramine maleate & pseudphedrine HCl) |
| Glutofac-MX (multimineral w/ iron) |
| Glutofac-ZX (multivitamin & multimineral w/ folic acid & zinc)) |
| LidaMantle Cream (lidocaine HCl) |
| LidaMantle HC Cream (lidocaine HCl & hydrocortisone acetate) |
| LidaMantle HC Lotion (lidocaine HCl & hydrocortisone acetate) |
| LidaMantle Lotion (lidocaine HCl) |
| Pamine (methscopolamine BR) |
| Pamine Forte (methscopolamine BR) |
| Rosula (sodium sulfacetamide & sulfur) |
| Tyzine (tetrahydrozoline HCl) |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form Application Form |
(Requires Acrobat Reader) 
|
| |
|
|