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Patient Assistance Information

1 Program for Zarxio
Sandoz One Source Program

P.O. Box 220188
Charlotte, NC 28222
Phone : (844)726-3691
Fax: (844)726-3695
> Patients must have no prescription coverage. Income requirements have not been disclosed. The medication must be determined as medically necessary by a doctor and the patient must be a US resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or download one.
> Doctors must complete a section, sign, and attach a brand name prescription. Patients must complete a section, sign, and attach required documents.
> Varies
Ship To
> Not specified
> This program also provides copay assistance.
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.
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form
(Requires Acrobat Reader