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Patient Assistance Information

 
 
 
Cubicin Reimbursement Hotline

Not Applicable
,
Phone : 866-793-2786 Ext OPT 2
Fax: 866-428-2478
Eligibility
> This program is based on guidelines that are not disclosed. This is a product replacement program.
Who Can Apply
> The doctor, patient, social worker or patient advocate must call for a prescreening.
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 or specific site (clinic, hospital, infusion site etc.)
Note
> The doctor, patient, social worker or patient advocate must call for a prescreening.
 
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.
 
Cubicin Injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader