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Patient Assistance Information

 
1 Program for LidaMantle Lotion (lidocaine HCl)
 
 
Bradley Pharmaceuticals Patient Assistance Program

383 Route 3 West
Fairfield, NJ 07004
Phone : (800) 929-9300 Ext 584
Fax:
Eligibility
> Eligibility is based on income and lack of third party prescription coverage.
Who Can Apply
> Application information is taken over the phone.
Required
> Caller must provide complete physician information (including DEA, State License, phone and fax numbers) as well as complete patient information.
Supply
> 90 days.
Ship To
> Physician's office.
Note
>
 
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.
 
LidaMantle Lotion (lidocaine HCl)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader