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Bradley Pharmaceuticals Patient Assistance Program
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383 Route 3 West
Fairfield, NJ 07004
Phone
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(800) 929-9300
Ext 584
Fax:
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Eligibility
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Eligibility is based on income and lack of third party prescription coverage. |
| Who Can Apply
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Application information is taken over the phone. |
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Required
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Caller must provide complete physician information (including DEA, State License, phone and fax numbers) as well as complete patient information. |
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Supply
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90 days. |
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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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| Anamantle HC (lidocaine HCl & hydrocortisone acetate) |
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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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