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Berlex Oncology CamCare Program
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Berlex Oncology CamCare Program
PO Box 221289
Charlotte, NC 28222-1289
Phone
:
(800) 473-5832
Fax:
(800) 513-1824
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Eligibility
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Patient must be physicially residing in the US or its territories and must be ineligible for third party prescription coverage. |
| Who Can Apply
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Anyone may call to initiate application process.
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Required
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Completed application with original signatures is required. |
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Supply
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As requested by physician. |
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Ship To
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Physician's office. |
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Note
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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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| Fludara (fludarabine phosphate) |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Application Form |
(Requires Acrobat Reader) 
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REACH (Resources for Expert Assistance and Care Helpline)
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PO Box 221289
Charlotte, NC 28222-1289
Phone
:
877-322-4448
Fax:
866-639-5181
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Eligibility
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The patient may be uninsured or be insured but experiencing difficulty accessing the medications. the patient must also also have limited financial resources. |
| Who Can Apply
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With the patient's permission, anyone concerned can call for an application. |
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Required
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The doctor must complete the appropriate section and sign the application.The patient must also complete, sign the application and attach proof of income. |
|
Supply
|
| > |
|
|
Ship To
|
| > |
Doctor's office |
|
Note
|
| > |
With the patient's permission, anyone concerned can call for an 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.
|
| Fludara (fludarabine phosphate) |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form Application Form |
| (Requires Acrobat Reader)
|
| |
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