Contact info
- Phone
- 1-888-474-3657
- Fax
- 1-866-557-8706
- Mailing address
- PO Box 5428Williamsburg, VA, VA 23188
Eligibility
- Patient must be uninsured.
- Patients with Medicare Part D are not eligible.
- Income limit, single
- 250% of the federal poverty level
- Income limit, couple
- 250% of the federal poverty level
- 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
- Proof of income
- Prescriber license number
- NPI number
- Both DEA and state license numbers
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Not published
Getting the medication
- Patient receives
- Medication
- Shipped to
- Not published
- Supply per shipment
- 1 dose
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published
Medications covered
- HyperHEP B (hepatitis B immune globulin human injection)
- HyperRAB (rabies immune globulin human injection)
- HyperTET (tetanus immune globulin human injection)