Contact info
- Phone
- 1-844-546-9772
- Fax
- 1-855-886-2482
- Mailing address
- 290 W. Mt. Pleasant AveBuilding 2, 4th Fl., Suite 4210Livingston, NJ 07039
Eligibility
- Eligibility is determined on case-by-case basis.
- Patient must meet program income guidelines which are not disclosed and based on FPL.
- Program offers o-pay assistance, reimbursement support, and patient assistance programs for eligible patients.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Yes
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Not published
- Prescriber license number
- NPI number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Varies
- Shipped to
- Varies
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published
Medications covered
- Kimyrsa (oritavancin injection)