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      Patient Assistance Program Center

Program Details

Johnson & Johnson Patient Assistance Program

Address: Patient Assistance Program
PO Box 221857
Charlotte, NC 28222-1857
Phone: 1-800-652-6227 Provider Phone:
Fax: 1-888-526-5168 Website: Program Website
Eligibility Info:
  • Patients are eligible who lack access to prescription drug coverage and meet specific financial criteria.
  • Some Medicare Part D patients who cannot afford their medicines, and who meet certain financial criteria, may also be eligible for assistance. Please call the Johnson & Johnson Patient Assistance Foundation, Inc. at 1-800-652-6227 for more information.
  • Income at or below: Single % FPL
      Couple % FPL
    Federal Poverty Level Calculator Federal Poverty Level Calculator
    Other Income Requirements: Please call 1-800-652-6227 or visit Program website for specific FPL income requirements.
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    Attachments Required: Financial
    Patient Consent Form
    Physician License #
    Both DEA and State
    Prescriber Signature
    Application may be
    Eligibility determination
    letter sent:
    Both Provider and Patient
    Receives: Medication or Pharmacy card (see application for details)
    Shipped To: Either Provider and Patient
    Consult application for more details.
    Quantity in Shipment: Not Published
    Delivery Time: 0-1 week
    Re-application Policy: New application every 12 months
    Refill Policy: Refills are automatically sent.
    Other Information:

    Last Updated: 09/17/2015




    Application Forms
    & Instructions

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

    DocumentForm (English)

    Document HIV Common Application


    Print-friendly version

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