Contact info
- Phone
- 1-888-865-1222
- Fax
- 1-866-410-6241
- Mailing address
- PO Box 30317Bethesda, MD 20824-0317
Eligibility
- Patient must be uninsured or underinsured.
- Patients with Medicare Part D are not eligible. Patient must meet program income guidelines which are not disclosed.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- No
- 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
- Not published
Getting the medication
- Patient receives
- Medication
- Shipped to
- Not published
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published
Medications covered
- Bronchitol Inhalation (mannitol)