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Sandoz One Source Program
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P.O. Box 220188
Charlotte, NC 28222
Phone
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(844)726-3691
Fax:
(844)726-3695
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Eligibility
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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
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Patients or healthcare providers can call to have an application faxed or download one. |
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Required
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Doctors must complete a section, sign, and attach a brand name prescription. Patients must complete a section, sign, and attach required documents. |
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Supply
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Varies |
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Ship To
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Not specified |
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Note
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This program also provides copay assistance. |
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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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| Zarxio |
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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 |
(Requires Acrobat Reader) 
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