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Patient Assistance Information

 
 
 
Eligard Patient Assistance Program


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Phone : 877-354-4273
Fax:
Eligibility
> Patients must be uninsured or underinsured, meet income requirements that have not been disclosed, have and FDA-approved diagnosis and be a US resident.
Who Can Apply
> Patients or healthcare providers must call for an application to be faxed.
Required
> Patients and doctors must each complete a section of the application and sign.
Supply
> Not specified
Ship To
> Not specified
Note
>
 
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.
 
Eligard injection