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Patient Assistance Information

 
Program Sponsored By Nutricia North America (External Link)
 
 
Neocate Assistance Program (NAP)

12800 Garden Grove Blvd., Suite 1
Garden Grove, CA 92843
Phone : (800)365-7354 Ext 1200
Fax: (877)777-0164
Eligibility
> This program provides brand name medications at no or low cost that have no prescription coverage for the requested medication and are not eligible for any federal or state programs. Medicare Part D recipients are not eligible. Income requirements for this program have not been disclosed. Patients must have a medically appropriate diagnosis and must be a US citizen or legal resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or mailed. An application can also be downloaded.
Required
> Doctors must complete a section of the application and sign. Patients must complete a section of the application, sign and attach proof of income and Medicaid denial. The application and documentation must then be faxed or mailed.
Supply
> Varies
Ship To
> Patient's home
Note
> Contact program for Spanish application.
 
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.
 
Neocate Infant DHA and ARA powder
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader