Program Contact Info / Application Submission
Program	Retassist Retavase Patient Assistance Program
Company	GenzymeRen
Address	PO Box 83177 Gaithersburg, MD 20883
Phone	866-437-7742, opt 4
Fax	301-869-3585
Program Details
Details	The amount requested is sent to the hospital.
Program Requirements
Information	Someone from the hospital must fill out a product request form for each replacement. The patient must provide information (financial, insurance, and medical) but no signature is required.
Details	Proof of Income required
Delivery of Medication
Delivery Options	Can be delivered directly to the doctor
Application Process
App Process	Someone from the hospital must call for an application. The application is sent to the hospital. The completed application can be faxed or mailed back.
New Applications	Doctors can apply directly to the program
Re-Applications	Doctors can apply for Re-Applications
Eligibility
Eligibility	The patient must have no insurance and have an income at or below 200% of the Federal Poverty Level. This is a hospital replacement program.