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Patient Assistance Information

 
1 Program for Deconamine SR (chlopheniramine maleate & pseudphedrine 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.
 
Deconamine SR (chlopheniramine maleate & pseudphedrine HCl)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader