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Astellas Stock Replacement Program For Mycamine
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PO Box 221644
Chantilly, VA 20153-1644
Phone
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800-477-6472
Fax:
703-968-2909
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Eligibility
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The patient must meet insurance and income guidelines that are not disclosed. |
| Who Can Apply
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The doctor, social worker, or physician office staff must call to pre-screen the patient for enrollment. |
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Required
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The doctor must fill out a section and sign the application.The patient must provide information (financial, insurance, and medical) but no signature is required. |
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Supply
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The product that was used will be replaced to the facility. |
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Ship To
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Doctor's office |
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Note
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The doctor, social worker, or physician office staff must call to pre-screen the patient for enrollment. |
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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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| Mycamine Injection |
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