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      Patient Assistance Program Center

Program Details

Patient Assistance Program

Oxycontin CR (Oxycodone hcl controlled-release)
Address: PO Box 66547
St. Louis, MO 63166-6547
Phone: 1-800-599-6070 Provider Phone:
Fax: Website: Program Website
Eligibility Info:
  • Patients must not have insurance coverage and must be ineligible for any state or federal programs.
  • Income at or below: Single 139 % FPL
      Couple 139 % FPL
    Federal Poverty Level Calculator Federal Poverty Level Calculator
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    Attachments Required: Financial
    Proof of residency
    Physician License #
    Not Published
    Prescriber Signature
    Application may be
    Eligibility determination
    letter sent:
    Receives: Medication
    Shipped To: Patient
    Quantity in Shipment: 30 days
    Delivery Time: 0-1 week
    Re-application Policy: New application every 12 months
    New financial information every 12 months
    Refill Policy: Varies by medication
    Other Information:

    Last Updated: 05/20/2015




    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


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