Adenocard Adenoscan
AmBisome Aristocort A Cefizox Cyclocort
| Pharmaceutical Company |
Fujisawa Healthcare
Inc. Patient Assistance Program |
| Program Address |
n.a. |
| Toll Free Phone Number |
800-477-6472 |
| Alternate Phone Number |
n/a |
| Fax Number |
703-968-2909 |
| Guidelines and Notes |
This program only provides help on a one time
only basis if the medication is available. |
| Initiating Enrollment |
Healthcare provider must call to obtain drug rerquest
form. |
| Health Provider's Role |
Completes form and prescription |
| Patient's Role |
Provides proof of income. |
| How Dispensed |
Via FedEx or UPS to provider |
| Amount Dispensed |
Depends on availability of medication |
| Refills |
n/a. |
| Limit |
One time only |