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Mission Pharmaceutical Patient Assistance Program
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Customer Services
PO Box 786099
San Antonio, TX 78278-6099
Phone
:
800-292-7364
Fax:
800-681-4050
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Eligibility
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The patient must have no insurance and be financially unable to afford the medication. Patients must be at or below 100% of the federal poverty level. The patient must have a medically appropriate diagnosis and must also be a US citizen. |
| Who Can Apply
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The doctor/doctor's office must send a letter indicating the patient needs this medication, duration, diagnosis, patient name, contact name, phone and fax numbers. An application will then be sent to the doctor's office. |
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Required
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The doctor must fill out a section, sign the application and attach a prescription. Then application can then be faxed of mailed from the doctor's office. |
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Supply
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Up to a 90-day supply |
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Ship To
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Doctor's office |
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Note
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Contact the program for more details (1-800-292-7364). |
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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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| Lithostat tablet |
| Uribel capsule |
| Urocit-K tablet; extended release |
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Mission Product Request
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Phone
:
877-425-0325
Fax:
877-426-2795
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Eligibility
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This program is for healthcare professionals only. Eligibility requirements for this program have not been disclosed. |
| Who Can Apply
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The Doctor should call for an application or download it from the website. |
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Required
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Doctors must complete and sign the application. |
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Supply
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Varies |
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Ship To
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Doctor's office |
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Note
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Resources for HEALTHCARE PROFESSIONAL ONLY.
The Doctor must contact the program to place an order. |
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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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| Avar LS cleanser |
| Avar-e LS emollient; cream |
| Binosto tablet; effervescent |
| Calcet creamy bites |
| CitraNatal 90 DHA tablet |
| CitraNatal Assure tablet |
| CitraNatal B-Calm tablet |
| CitraNatal Harmony capsule; gel |
| Dr. Smiths Diaper Rash Ointment ointment |
| Eletone cream |
| Ferralet 90 tablet |
| Lycelle head lice removal kit |
| Oncovite oral |
| Ovace Plus shampoo |
| Ovace Plus Wash gel |
| Prednisolone oral solution |
| Texacort solution; topical |
| Tindamax tablet |
| Uribel capsule |
| Urocit-K tablet; extended release |
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