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Gateway to Nucala
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PO Box 221797
Charlotte, NC 28222
Phone
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(844)468-2252
Fax:
(844)237-3172
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Eligibility
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This program is intended for patients that have insurance. Medicare Part D patients are not eligible for this program. Income requirements vary. Must reside in the US, DC, Puerto Rico or the USVI. |
| Who Can Apply
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Call to have application faxed or mailed or download. Return application via fax. |
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Required
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Medically appropriate condition/diagnosis required. Doctor and Patient must complete and sign application. |
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Supply
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Amount/supply not specified. Refill process and limit not specified. Re-application process not specified. |
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Ship To
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Shipping location varies. Delivery time varies. |
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Note
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This program also provides copay assistance. |
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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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| Nucala |
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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 Gateway to Nucala |
(Requires Acrobat Reader) 
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