Drug Information
Drug	sulfasalazine tablets 500mg
Brand Equivalent	Alzulfidine 500 mg
Program Contact Info / Application Submission
Program	Xubex Patient Assistance Program
Company	Xubex
Form	Download PDF
Address	PO Box 1244 Winter Park, Fl 32790-1244
Phone	866-699-8239
Fax	407-671-7960
Website	http://www.xubex.com
Program Requirements
Information	Payment is required with applications.
Details	Insurance card required Drivers license required
Delivery of Medication
Delivery Options	Can NOT be delivered directly to the patient Can NOT be delivered directly to the doctor Shipped as a voucher card
Application Process
App Process	The application can be mailed in with a check or money order and a 90-day prescription, or faxed in with credit card information.
New Applications	New applications NOT accepted Patients can NOT apply directly to the program Doctors can NOT apply directly to the program Advocates can NOT apply directly to the program Can apply for a new application via phone Can NOT apply for a new application via fax Can NOT apply for a new application via mail
Refills	Refills NOT accepted Patients can NOT apply for refills Doctors can NOT apply for refills Advocates can NOT apply for refills Can NOT apply for refills via phone Can NOT apply for refills via fax Can NOT apply for refills via mail
Re-Applications	Re-Applications NOT accepted Patients can NOT apply for Re-Applications Doctors can NOT apply for Re-Applications Advocates can NOT apply for Re-Applications Can Re-Apply via phone Can NOT Re-Apply via fax Can NOT Re-Apply via mail
Appeals	Income Appeals accepted Patients can apply for Income Appeals Doctors can apply for Income Appeals Advocates can apply for Income Appeals Hardship Appeals accepted Patients can apply for Hardship Appeals Doctors can apply for Hardship Appeals Advocates can apply for Hardship Appeals Can apply for an appeal via phone Can apply via fax Can apply for an appeal via mail
Eligibility
Eligibility	Eligibility is based on household income level. This is a generic program which charges a shipping and handling fee of $20-$40 depending on the medication.
Appeals
Conditions	Appeals must be made after the patient has been denied
Other Medications
Other  Medications  available in  this program	Albuterol Tablet 2mg - Bronchodilator Pulmo (Generic: ) Amiloride - HCTZ 5-50mg - diuretic BloodPressure (Generic: ) hydralazine - Vasodilator Blood Pressure (Generic: ) Aminophylline Tablet 100mg - Bronchodilator Pulmo (Generic: ) Captopril-HCTZ Tablet 25-15mg - ACE inhibitor + diuretic BloodPressure (Generic: ) Chlordiazepoxide Tablet 5mg - benzodiazepines Neuro/ Mental Health (Generic: ) Chlorpropamide Tablet 250mg - Diabetic (Generic: ) Chlorzoxazone Tablet 500mg - muscle relaxant Musculoskeletal (Generic: ) Ciprofloxacin Tablet 250mg - Antibiotic (Generic: ) Doxycycline 100mg - Antibiotic (Generic: ) doxycycline tablet - Antibiotic (Generic: ) Fluconazole Tablet 100mg - Antifungal (Generic: ) Fluphenazine 1mg - Neuro/Mental Health (Generic: ) Flurazepam 15mg - benzodiazepines Neuro/ Mental Health (Generic: ) Fosinopril Tablet 10mg - ACE inhibitor BloodPressure (Generic: ) hydralazine tablet - Vasodilator BloodPressure (Generic: ) hydroxyzine pamoate Capsules - Neuro/ Mental Health (Generic: ) isosorbide dinitrate tablet - Vasodilator Cardio (Generic: ) levothyroxine Injection - Thyroid (Generic: ) niacin tablet 500 mg - Vitamin B3 Supplements (Generic: ) oxybutynin chloride tablet 5mg - over-active bladder Urinary (Generic: ) sotalol hcl tablet 80mg - Beta-Blocker Cardio (Generic: ) sulfasalazine tablet 25mg - Rheumatoid Arthritis (Generic: ) sulindac tablet 150mg - NSAID Musculoskeletal (Generic: ) thyroid tablet 15mg - Thyroid Thyroid (Generic: ) trihexyphenidyl tablet 2mg - Parkinson's (Generic: ) sulindac tablet 200mg - NSAID Musculoskeletal (Generic: ) Cimetidine 300mg - Histamine-2 Antagonist Gastroenterology (Generic: ) sulfasalazine tablets 500mg - (Generic: ) Diltiazem Tablet 30mg - (Generic: ) Torsemide Tablets 5mg - (Generic: ) Torsemide Tablets 10mg - (Generic: ) Torsemide Tablets 20mg - (Generic: ) Torsemide Tablets 100mg - (Generic: ) Methotrexate Injection 25mg/ml - Rheumatoid Arthritis (Generic: ) Chlordiazepoxide / Clidinium capsule 5mg/2.5mg - IBS / Ulcers (Generic: ) Cetirizine HCI Tablet 5mg - (Generic: ) Cetirizine HCI Tablet 10mg - (Generic: ) Clotrimazole-Betamethasone Cream - (Generic: ) ipratropium bromide/albuterol sulfate Inhalation S - COPD Pulmo (Generic: ) Timolol Ophthalmic Solution 0.25% - Ophthalmic Solution Eye (Generic: ) Timolol Ophthalmic Solution 0.5% - Ophthalmic Solution Eye (Generic: ) Albuterol Tablet 4mg - (Generic: ) Alendronate Na 35mg - (Generic: ) Alendronate Na 5mg - (Generic: ) Alendronate Na 10mg - (Generic: ) Aminophylline Tablet 200mg - (Generic: ) Anucort-Hc Suppository - (Generic: ) Atenolol - Chlorthalidone 50-100mg - (Generic: ) Atropine Ophthalmic Solution 1% - (Generic: ) Captopril-HCTZ Tablet 25-25mg - (Generic: ) Captopril-HCTZ Tablet 50-25mg - (Generic: ) Captopril-HCTZ Tablet 50-15mg - (Generic: ) Chlordiazepoxide Tablet 10mg - (Generic: ) Chlordiazepoxide Tablet 25mg - (Generic: ) Cimetidine 400mg - (Generic: ) Cimetidine 800mg - (Generic: ) Ciprofloxacin Tablet 500mg - (Generic: ) Ciprofloxacin Tablet 750mg - (Generic: ) Cromolyn Ophthalmic Solution 4% - (Generic: ) Diltiazem Tablet 60mg - (Generic: ) Diltiazem Tablet 90mg - (Generic: ) Dipivefrin Ophthalmic Solution 0.1% - (Generic: ) Fluconazole Tablet 150mg - (Generic: ) Fluconazole Tablet 200mg - (Generic: ) Fluphenazine 2.5mg - (Generic: ) Fluphenazine 5mg - (Generic: ) Fluphenazine 10mg - (Generic: ) Fluphenazine Decanoate Injection 25mg-ml - (Generic: ) Flurazepam 30mg - (Generic: ) Flurbiprofen 50mg - (Generic: ) Flurbiprofen 100mg - (Generic: ) Foltab Tablet 800mg - (Generic: ) Fosinopril Tablet 20mg - (Generic: ) Fosinopril Tablet 40mg - (Generic: )