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Sandoz One Source Program
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P.O. Box 220188
Charlotte, NC 28222
Phone
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(844)726-3691
Fax:
(844)726-3695
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Eligibility
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Patients must have no prescription coverage. Income requirements have not been disclosed. The medication must be determined as medically necessary by a doctor and the patient must be a US resident. |
Who Can Apply
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Patients or healthcare providers can call to have an application faxed or download one. |
Required
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Doctors must complete a section, sign, and attach a brand name prescription. Patients must complete a section, sign, and attach required documents. |
Supply
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Varies |
Ship To
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Not specified |
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. |
Zarxio |
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Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form |
(Requires Acrobat Reader)
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