rxhelp360.org
| Program Contact Info / Application Submission | ||||||||||||||||||
| Program | Connection to Care (Lyrica) | |||||||||||||||||
| Company | PfizLyr | |||||||||||||||||
| Form | Download PDF | |||||||||||||||||
| Address | PO Box 66585, St. Louis, MO 63166-6585 | |||||||||||||||||
| Phone | 866-706-2400 | |||||||||||||||||
| Fax | 866-470-1748 | |||||||||||||||||
| Website | http://www.pfizerhelpfulanswers.com/pages/Programs/programdetails.aspx?p=2 | |||||||||||||||||
| Program Requirements | ||||||||||||||||||
| Details | Drivers license required Form 4506T (If taxes were not filed) required as proof of income | |||||||||||||||||
| Other Requirements | Copy of SS card and Drivers License | |||||||||||||||||
| Delivery of Medication | ||||||||||||||||||
| Ship Time | 2 - 3 weeks | |||||||||||||||||
| Delivery Options | Can be delivered directly to the patient Can NOT 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 Advocates 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 NOT apply for refills Doctors can apply for refills Advocates can NOT apply for refills Can apply for refills via phone Applying for refills via fax will be considered on a case by case basis Applying for refills via mail will be considered on a case by case basis | |||||||||||||||||
| Other Medications | ||||||||||||||||||
| Other Medications available in this program |
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