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MAP
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MAP
P. O. Box 222197 Charlotte, NC 28222-2197
Phone
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(877) 480-8082
Fax:
(877) 675-6513
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Eligibility
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Patient must have no form of health insurance and meet program's income guidelines. |
Who Can Apply
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Physician's office must call on patient's behalf. |
Required
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Provider must complete product request form on a monthly basis. |
Supply
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One cycle |
Ship To
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Physician's office. |
Note
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Faxed applications are accepted. Patient must re-apply if income or insurance status changes. |
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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. |
Synagis (palivizumab) |
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