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View Prescription Drug Assistance Program Details

Program Name: AstraZeneca Foundation Patient Assistance Program
Program Type: Pharmaceutical Company
Drugs Covered:  
Brand Name: Atacand
Generic Name:  
Company Name: Astrazeneca Pharmaceuticals
Address: AstraZeneca Foundation<br>Patient Assistance Program <br>P.O. Box 66551
City: St. Louis
State: MO
Zip Code: 63166-6551
Telephone: 8004243727
Telephone: 8006980085
Fax Number 3028868337
E-Mail: Dale.Ciccarelli@astrazeneca.com
Web Site: http://www.astrazeneca-us.com/content/drugAssistance/patientAssistanceProgram/default.asp
Enrollment Fee:  
Who Can Apply: Patient and Physician / Licensed Practitioner
Applications are evaluated on a case-by-case basis.Eligibility is based on income level/assets, absence of outpatient private insurance, third-party coverage, or participation in a public program. Income eligibility is based upon multiples of the U.S. poverty level adjusted for household size.You must forward a valid form of income documentation for each source of income with your application. Valid forms include: Social Security Benefit statementIncome documentation or pay stubs1099-INT for interest incomepension or annuity statementsfederal income tax return You must be a U.S. citizen with a valid Social Security Number.If you appear to be eligible for Medicaid, you will be required to provide proof of denial from state Medicaid coverage.
<b>For Iressa call 1-866-992-9276 option #1.</b>Your application will be processed 4 to 6 weeks after it is received by the foundation. You will be notified if you've been denied. If approved, the prescription portion of the application will be forwarded to the mail order pharmacy where a 3-month supply of medication will be express mailed to the "Ship To" address on the application. Two weeks before your 3-month supply of medication is depleted, you must call for a refill at 1-800-698-0085. You must re-apply to the Foundation every 12 months to see if you are still eligible to participate in the program. A reapplication is automatically sent to enrollees 45 days prior to their one-year expiration date.