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Eligard Patient Assistance Program
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Phone
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877-354-4273
Fax:
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Eligibility
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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
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Patients or healthcare providers must call for an application to be faxed. |
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Required
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Patients and doctors must each complete a section of the application and sign. |
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Supply
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Not specified |
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Ship To
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Not specified |
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Note
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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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| Eligard injection |
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