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Program Details

EMD SERONO
Fertility LifeLines - Compassionate Care Program

Ovidrel injection (choriogonadotropin alfa)
 
CONTACT INFO
Address:
,
Phone: 1-866-538-7879 Provider Phone:
Fax: Website: Fertility LifeLines
ELIGIBILITY
Eligibility Info:
  • Fertility LifeLines will help you determine what options may be available to help you with the costs of treatment.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Not Published
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    Physician License #
    Required:
    Not Published
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Both Provider and Patient
    MEDICATION
    Receives: Medication
    Shipped To: Provider
    Quantity in Shipment: Not Published
    Delivery Time: 0-1 week
    Re-application Policy:
    Refill Policy: No refills
    Other Information:

    Last Updated: 02/07/2013

     

     

     


    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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