| |
Xubex Pharmaceutical Services
|
PO Box 1244
Winter Park, FL 32790-1244
Phone
:
866-699-8239
Fax:
407-671-7960
|
|
Eligibility
|
| > |
Patients may have insurance. There are no income limits for this program. Patients must be a US resident. |
| Who Can Apply
|
| > |
Anyone requesting assistance can call to request a faxed application or download it from the website. |
|
Required
|
| > |
The doctor needs to provide a prescription to the patient.The patient must fill out a section and sign the application. |
|
Supply
|
| > |
Varies |
|
Ship To
|
| > |
Either Doctor's office or Patient's home |
|
Note
|
| > |
No proof of income is required. Check the website for the exact price.
This service is not currently available in Montana. |
| |
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.
|
| Tobradex ST ophthalmic suspension/drops |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form |
(Requires Acrobat Reader) 
|
| |
|
|