Drug: AmBisome injection

 
Drug Information
Drug AmBisome injection
Generic Equivalent amphotericin B, lipid-based
Topic Antifungals
 
Program Contact Info / Application Submission
Program Astellas Reimbursement Services
Company Astellas
Form Download PDF
Address PO Box 13185, La Jolla, CA 92039
Phone 800-477-6472
Fax 866-317-6235
Website http://www.astellasreimbursement.com/
 
Program Requirements
Details Proof of Income required
Copy of most recent tax return such as 1040, 1099 required as proof of income
 
Delivery of Medication
Ship Time 10 business days
Delivery Options Can be delivered directly to the patient
Can NOT be delivered directly to the doctor
Shipped as a voucher card
 
Application Process
New Applications New applications accepted
Patients can apply directly to the program
Doctors can apply directly to the program
Advocates can apply directly to the program

Can apply for a new application via phone
Can apply for a new application via fax
Can apply for a new application via mail
Refills Refills accepted
Patients can apply for refills
Doctors can apply for refills
Advocates can NOT apply for refills
Can apply for refills via phone
Can apply for refills via fax
Can NOT apply for refills via mail
Re-Applications Re-Applications accepted
Patients can apply for Re-Applications
Doctors can apply for Re-Applications
Advocates can NOT apply for Re-Applications

Can Re-Apply via phone
Can Re-Apply via fax
Can NOT Re-Apply via mail
 
Other Medications
Other
 Medications
 available in
 this program
Adenoscan IV 20ml - Pharmacologic Stress Agent Cardio (Generic: adenosine)
AmBisome injection - Antifungals (Generic: amphotericin B, lipid-based)
VESIcare 5mg - Overactive Bladder Urinary (Generic: solifenacin succinate)
VESIcare 10mg - (Generic: solifenacin succinate)