| |
Ferndale Laboratories Patient Assistance Program
|
Customer Services
780 West Eight Mile Rd.
Ferndale, MI 48220
Phone
:
800-621-6003
Ext 421
Fax:
248-548--0279
|
|
Eligibility
|
| > |
The Patient may have insurance, including Medicare partD. Income requirements are based on FPL. Must be a US resident. No diagnosis/medical criteria required. |
| Who Can Apply
|
| > |
Call to get application faxed, mailed or emailed, application can be returned via fax, mail or email. Patient will be notified in 7-10 business days. |
|
Required
|
| > |
Doctor must complete and sign application. Patient must complete application, sign, and attach copy of income. |
|
Supply
|
| > |
Amount requested is sent. Patient or Doctor must contact company for refills. No refill limit. New application must be completed yearly. |
|
Ship To
|
| > |
Medication will be shipped to Doctor's office or Patient's home within 7-10 business days. |
|
Note
|
| > |
Eligibility determined on a case-by-case basis.
Contact program for Spanish 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.
|
| Analpram HC lotion |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form Ferndale Laboratories Patient Assistance Program |
(Requires Acrobat Reader) 
|
| |
|
|