Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
 
 
TEVA Patient Assistance Program for Clozapine

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