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Daiichi Sankyo Open Care Program
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PO Box 8409
Somerville, NJ 08876
Phone
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866-268-7327
Ext 1
Fax:
Not Applicable
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Eligibility
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This program is intended for patients that are uninsured. Medicare Part D patients are not eligible for this program. Patient's income must be at or below 200% FPL. Must be citizen or legal resident. |
| Who Can Apply
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The physician's office must call for application, which will be faxed. Application can be returned via fax or mail. Patient will be notified of denial in writing. |
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Required
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Doctor must complete section, sign, attach required documents. Patient must complete section, sign, attach a copy of proof of income. |
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Supply
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Up to 90 day supply. Patient or Doctor must contact company for refills. Refill limit not specified. New application and documentation is required yearly. |
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Ship To
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Medication is sent to Doctor's office within 2 weeks. |
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Note
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No online application available. |
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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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| Tribenzor tablet |
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