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Ferndale Laboratories Patient Assistance Program
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Customer Services
780 West Eight Mile Rd.
Ferndale, MI 48220
Phone
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800-621-6003
Ext 421
Fax:
248-548--0279
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Eligibility
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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
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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. |
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Required
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Doctor must complete and sign application. Patient must complete application, sign, and attach copy of income. |
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Supply
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Amount requested is sent. Patient or Doctor must contact company for refills. No refill limit. New application must be completed yearly. |
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Ship To
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Medication will be shipped to Doctor's office or Patient's home within 7-10 business days. |
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Note
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Eligibility determined on a case-by-case basis.
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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| LMX cream; anesthetic |
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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 Ferndale Laboratories Patient Assistance Program |
(Requires Acrobat Reader) 
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