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Patient Assistance Information

 
2 Programs Sponsored By Mission Pharmacal Co. (External Link)
 
 
Mission Pharmaceutical Patient Assistance Program

Customer Services
PO Box 786099
San Antonio, TX 78278-6099
Phone : 800-292-7364
Fax: 800-681-4050
Eligibility
> 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
> 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.
Required
> 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.
Supply
> Up to a 90-day supply
Ship To
> Doctor's office
Note
> Contact the program for more details (1-800-292-7364).
 
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.
 
Lithostat tablet
Uribel capsule
Urocit-K tablet; extended release
 
 
 
Mission Product Request


,
Phone : 877-425-0325
Fax: 877-426-2795
Eligibility
> This program is for healthcare professionals only. Eligibility requirements for this program have not been disclosed.
Who Can Apply
> The Doctor should call for an application or download it from the website.
Required
> Doctors must complete and sign the application.
Supply
> Varies
Ship To
> Doctor's office
Note
> Resources for HEALTHCARE PROFESSIONAL ONLY. The Doctor must contact the program to place an order.
 
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.
 
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