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Covidien/Mallinckrodt Patient Assistance Program
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Max Care
PO Box 16430
Oklahoma City, OK 73113
Phone
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800-259-7765
Ext opt3
Fax:
405-213-1521
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Eligibility
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Covidien/Mallinckrodt Patient Assistance Program is a discount card program available to uninsured or underinsured patients. Income requirements for this program have not been disclosed. |
| Who Can Apply
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Patients can call to for an application or print one from the link below. |
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Required
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Doctors must provide patients with a prescription. Patients must complete, sign, attach a copy of proof of income and fax or mail the application. A new application is needed yearly. |
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Supply
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Up to a 30 day supply or 90 quantity |
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Ship To
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Patient is sent a card to be used at the pharmacy. |
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Note
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For the medication Exalgo, the quantity is 120.
For the medication Roxicodone, the quantity is 360 for the 15mg and 180 for the 30mg.
If accepted, the patient must pay a copay of $20.
Contact program for Spanish application. |
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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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| Anafranil Capsules |
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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 |
(Requires Acrobat Reader) 
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