|
Cubicin Reimbursement Hotline
|
Not Applicable
,
Phone
:
866-793-2786
Ext OPT 2
Fax:
866-428-2478
|
Eligibility
|
> |
This program is based on guidelines that are not disclosed. This is a product replacement program. |
Who Can Apply
|
> |
The doctor, patient, social worker or patient advocate must call for a prescreening. |
Required
|
> |
The doctor must fill out a section and sign the application.The patient must fill out a section and sign the application. |
Supply
|
> |
|
Ship To
|
> |
Hospital, Doctor's office or specific site (clinic, hospital, infusion site etc.) |
Note
|
> |
The doctor, patient, social worker or patient advocate must call for a prescreening. |
|
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. |
Cubicin Injection |
|
Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form Application Form |
(Requires Acrobat Reader)
|
|
|