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Patient Assistance Information

 
1 Program for Augmentin ES-600 Powder for Oral Suspension
 
 
GlaxoSmithKline Bridges to Access Program

PO Box 29038,Phoenix, AZ 85038-9038
Phoenix, AZ 85038-9038
Phone : 866-728-4368
Fax:
Eligibility
> The patient must have no prescription coverage for the requested medication and have an income at or below 250% of the Federal Poverty Level. The patient must also be a US resident.
Who Can Apply
> The patient advocate can call for an application or start the application process on line.
Required
> The doctor must fill out a section, sign the application and attach a prescription.The patient must fill out a section, sign the application, and attach proof of income and any denial letters from insurance companies.
Supply
>
Ship To
> Patient's home advocate
Note
> The patient advocate can call for an application or start the application process on line.
 
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.
 
Augmentin ES-600 Powder for Oral Suspension