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Synvisc Connection Personalized Reimbursement Solutions
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PO Box 222138
Charlotte, NC 28222
Phone
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888-847-4877
Fax:
888-847-1797
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Eligibility
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Patients must be uninsured, be at or below 250% of the Federal Poverty Level, have osteoarthritis of the knee, be a US resident and have a social security number. |
Who Can Apply
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Patients or healthcare providers can call to have an application faxed or download one. |
Required
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Doctors must complete a section of the application and sign. Patients must complete a section of the application, sign and attach proof of income. |
Supply
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Varies |
Ship To
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Doctor's office |
Note
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The doctor must only have two patients enrolled every six months.
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. |
Synvisc syringe; prefilled |
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Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form |
(Requires Acrobat Reader)
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