rxhelp360.org
| 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 |
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