rxhelp360.org
| Program Contact Info / Application Submission | ||||
| Program | Carbatrol Shire US Patient Assistance Program | |||
| Company | ShireCarb | |||
| Form | Download PDF | |||
| Program Requirements | ||||
| Details | Insurance card NOT required Drivers license NOT required Proof of Income NOT required Copy of most recent tax return such as 1040, 1099 NOT required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement NOT required as proof of income | |||
| Delivery of Medication | ||||
| Delivery Options | Can NOT be delivered directly to the patient Can be delivered directly to the doctor | |||
| Application Process | ||||
| New Applications | New applications accepted Patients can apply directly to the program Doctors can apply directly to the program Can NOT apply for a new application via phone Can NOT 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 Can NOT apply for refills via phone Can NOT apply for refills via fax Can apply for refills via mail | |||
| Re-Applications | Re-Applications accepted Patients can apply for Re-Applications Doctors can apply for Re-Applications Can NOT Re-Apply via phone Can NOT Re-Apply via fax Can Re-Apply via mail | |||
| Other Medications | ||||
| Other Medications available in this program |
| |||
|
|
||||||||||||||||||||
|
|
||||||||||||||||||||
