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Patient Assistance Information

 
1 Program for Ambien CR Tablets
 
 
Together Rx Access

PO Box 9426
Wilmington, DE 19809-9944
Phone : 800-444-4106
Fax:
Eligibility
> The patient must have no insurance and have an income at or below $30,000 for an individual ($60,000 for a family of four) The patient must also be a US resident.
Who Can Apply
> The patient can call to get an application, apply on line, or download the application.
Required
> Eligible people simply respond to four questions to enroll.
Supply
> Together Rx Access prescription savings card.
Ship To
> Patient's home
Note
> The patient can call to get an application, apply on line, or download the 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.
 
Ambien CR Tablets
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader