| Pharmaceutical Company | Genentech, Inc. |
| Program Address | Genentech, Inc. Uninsured Pt Assist. Program 1 DNA Way, Mail Stop 13A So. San Francisco CA 94080-4990 |
| Toll Free Phone Number | 800-530-3083 |
| Alternate Phone Number | 800-879-4747 |
| Fax Number | 650-225-1366 |
| Guidelines and Notes | They will help patients who are underinsured or uninsured. Call 8-5 PST For Activase,patient's annual gross income must be less than $30,000. Income guidlines for other growth hormones is not disclosed. For Activase, Rituxan and Hercepton, indigent patient applies after receiving the product; the hospital is sent replacement product and application is made on behalf of the patient by the facility within one year of treatment. For Herceptin, Rituxan, Activase or TNKase call 800-530-3083; for Nutroin, Nutropin AQ, Nutropin Depot or Proptropin, call 800-879-4747. |
| Initiating Enrollment | Call company between 8-5 Pacific Standard Time |
| Health Provider's Role | Doctor completes and signs statement of medical necessity. |
| Patient's Role | Copy of most recent tax return and W-2's needed for growth hormone application. |
| How Dispensed | Product sent to family or doctor. For Activase, replacement product is sent t o the hospital. |
| Amount Dispensed | For growth hormone, depends on dosage. |
| Refills | Provider calls company.. |
| Limit | Unspecified |