Program Details
ULTRAGENYX PHARMACEUTICAL, INC.
UltraCare Patient Assistance Program
Mepsevii
(vestronidase alfa-vjbk injection)
|
CONTACT
INFO |
|
Address: |
5000 Marina Boulevard
Brisbane, CA 94005 |
Phone: |
1-888-756-8657 |
Provider Phone: |
|
Fax: |
1-415-723-7474 |
Website: |
Program Website |
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ELIGIBILITY
|
|
Eligibility
Info: |
Eligibility is determined on a case-by-case basis.
Program provides co-pay assistance, reimbursement support, and patient assistance programs for eligible patients. |
|
Couple |
|
% FPL |
Income at or below: |
Not
Published |
Medical expenses
can be deducted from reported income: |
Not
Published |
Social security requested on form: |
Yes |
US citizenship/residency specified:
|
Not
Published |
|
APPLICATION |
|
Attachments
Required: |
Not Published
|
Physician
License #
Required: |
State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Not Published
|
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MEDICATION |
|
Receives: |
Medication
|
Shipped To: |
Either Provider and Patient
|
Quantity in
Shipment: |
Not Published
|
Delivery Time: |
Not Published
|
Re-application
Policy: |
New application every 12 months
|
Refill Policy: |
Not Published
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Other Information: |
|
|
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Last Updated: 04/19/2024
www.RxAssist.org
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