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Patient Assistance Information

Astellas Stock Replacement Program For AmBisome

PO Box 220708
Charlotte, NC 28222
Phone : 800-477-6472
Fax: 866-317-6235
> The patient must meet income and insurance guidelines that are not disclosed.
Who Can Apply
> The doctor, social worker, or physician office staff must call to pre-screen the patient for enrollment.
> The doctor must fill out a section and sign the application.The patient must provide information (financial, insurance, and medical) but no signature is required.
> The product that was used will be replaced for the facility.
Ship To
> Doctor's office.
> Allow 10 business days for the processing and delivery of medication.
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.
Ambisome Injection