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Patient Assistance Information

 
 
 
Imogam and ImoVax Patient Assistance Program

C/O NORD
PO Box 1968
Danbury, CT 06813-1968
Phone : 877-798-8716
Fax: 203-798-2964
Eligibility
> The patient must have no prescription coverage for the requested medication and have a low income based on the Federal Poverty Guidelines. The patient must also be a US resident.
Who Can Apply
> The doctor/doctor's office must call for a prescreening.
Required
> The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income.
Supply
>
Ship To
> Doctor's office
Note
> The doctor/doctor's office must call for a prescreening.
 
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.
 
Imogam
Imovax Rabies IM (Rabies Vaccine)