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Patient Assistance Information

Mission Pharmaceutical Patient Assistance Program

Customer Services
PO Box 786099
San Antonio, TX 78278-6099
Phone : 800-292-7364
Fax: 800-681-4050
> The patient must have no insurance and be financially unable to afford the medication. Patients must be at or below 100% of the federal poverty level. The patient must have a medically appropriate diagnosis and must also be a US citizen.
Who Can Apply
> The doctor/doctor's office must send a letter indicating the patient needs this medication, duration, diagnosis, patient name, contact name, phone and fax numbers. An application will then be sent to the doctor's office.
> The doctor must fill out a section, sign the application and attach a prescription. Then application can then be faxed of mailed from the doctor's office.
> Up to a 90-day supply
Ship To
> Doctor's office
> Contact the program for more details (1-800-292-7364).
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.
Lithostat tablet
Uribel capsule
Urocit-K tablet; extended release