| |
Support Program
|
,
Phone
:
855-847-9435
Fax:
855-847-9478
|
|
Eligibility
|
| > |
Patient must have no insurance or no prescription coverage. Income requirements will be based on the Federal Poverty Level. Patients must have a medically appropriate condition/diagnosis and be a US resident. |
| Who Can Apply
|
| > |
Patients or healthcare providers can call to have an application faxed or mailed. |
|
Required
|
| > |
Doctors must complete a section of the application and sign. Patients must complete a section, sign, attach proof of income and other requested documentation. |
|
Supply
|
| > |
Not applicable |
|
Ship To
|
| > |
Not applicable |
|
Note
|
| > |
This Company also offers a Reimbursement Program. |
| |
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.
|
| Vibativ vial |
| |
| |
|
|