Program Contact Info / Application Submission
Program	Purinethol Access Program
Company	GatesPharm
Address	PO Box 52028 Phoenix, AR 85072-9937
Phone	877-254-1039
Fax	888-782-6157
Program Details
Details	The medication is sent to the doctor's office. The doctor/doctor's office must contact the company to arrange refills. Every 6 months a new application is needed.
Program Requirements
Information	The doctor must fill out a section and sign the application. The patient must fill out a section and sign the application.
Details	Proof of Income required
Delivery of Medication
Delivery Options	Can be delivered directly to the doctor
Application Process
App Process	The doctor/doctor's office should call for an application. The application is sent to the doctor's office. The completed application can be faxed or mailed back. The doctor is notified of acceptance or denial.
Refills	Doctors can apply for refills
Re-Applications	Doctors can apply for Re-Applications
Eligibility
Eligibility	The patient must have no prescription coverage for the requested medication and have an income at or below 200% of the Federal Poverty Level. The patient must also be a US resident. Discount cards are not considered insurance. If patient has reached her/his cap s/he should still apply because s/he may still be eligible.