|
Xubex Pharmaceutical Services
|
PO Box 1244
Winter Park, FL 32790-1244
Phone
:
866-699-8239
Fax:
407-671-7960
|
Eligibility
|
> |
Patients may have insurance. There are no income limits for this program. Patients must be a US resident. |
Who Can Apply
|
> |
Anyone requesting assistance can call to request a faxed application or download it from the website. |
Required
|
> |
The doctor needs to provide a prescription to the patient.The patient must fill out a section and sign the application. |
Supply
|
> |
Varies |
Ship To
|
> |
Either Doctor's office or Patient's home |
Note
|
> |
No proof of income is required. Check the website for the exact price.
This service is not currently available in Montana. |
|
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. |
Zenzedi tablet |
|
Printable Application Forms Applications that patients can fill out and bring to their doctor. |
Download printable Form |
(Requires Acrobat Reader)
|
|
|