Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
1 Program for Granix injection
 
 
CORE Patient Assistance Program

PO Box 7588
Overland Park, KS 66207
Phone : 888-587-3263
Fax: 866-676-4073
Eligibility
> Patients must have no prescription coverage for the needed medication, be at or below 500% of the Federal Poverty Level, have a medically appropriate diagnosis/condition and be a citizen or legal resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or mailed. It can also be downloaded.
Required
> Doctors must complete a section and sign. Patients must complete a section, sign, attach a copy of proof of income, and attach front and back copy of insurance card.
Supply
> Not specified
Ship To
> Doctor's office
Note
> 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.
 
Granix injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader