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Patient Assistance Information

 
 
 
Mission Product Request


,
Phone : 877-425-0325
Fax: 877-426-2795
Eligibility
> This program is for healthcare professionals only. Eligibility requirements for this program have not been disclosed.
Who Can Apply
> The Doctor should call for an application or download it from the website.
Required
> Doctors must complete and sign the application.
Supply
> Varies
Ship To
> Doctor's office
Note
> Resources for HEALTHCARE PROFESSIONAL ONLY. The Doctor must contact the program to place an order.
 
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.
 
Avar LS cleanser
Avar-e LS emollient; cream
Binosto tablet; effervescent
Calcet creamy bites
CitraNatal 90 DHA tablet
CitraNatal Assure tablet
CitraNatal B-Calm tablet
CitraNatal Harmony capsule; gel
Dr. Smiths Diaper Rash Ointment ointment
Eletone cream
Ferralet 90 tablet
Lycelle head lice removal kit
Oncovite oral
Ovace Plus shampoo
Ovace Plus Wash gel
Prednisolone oral solution
Texacort solution; topical
Tindamax tablet
Uribel capsule
Urocit-K tablet; extended release