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Patient Assistance Information

 
1 Program for Actimmune Injection
 
 
Actimune Patient Assistance Program

PO Box 4280
Gaithersburg, MD 20885
Phone : 800-577-9112 Ext 1
Fax: 240-632-3873
Eligibility
> This program is based on guidelines that are not disclosed. The medication must be used for a FDA-approved diagnosis.
Who Can Apply
> The doctor, patient, social worker or patient advocate must call for a prescreening.
Required
> The doctor must fill out a section, sign the application and attach a copy of the DEA or State License number.The patient must fill out a section, sign the application and attach proof of income.
Supply
> A 90-day supply
Ship To
> Hospital, Doctor's office or Pharmacy
Note
> The doctor, patient, social worker or patient advocate must call for a prescreening.
 
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.
 
Actimmune Injection