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TEVA Patient Assistance Program for Clozapine
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Teva Patient Assistance Program for Clozapine
50 NW 176th Street
Miami, FL 33169
Phone
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800-507-8334
Ext OPT 3
Fax:
800-507-8339
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Eligibility
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The patient must have no prescription coverage for any medications and meet income guidelines that are not disclosed. |
| Who Can Apply
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section and sign the application. |
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Supply
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Ship To
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Hospital, Doctor's office, Patient's home or Pharmacy |
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Note
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Anyone requesting assistance can call to request a faxed application or download it from the website. |
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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.
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| Clozapine Tablets |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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