CONTACT
INFO |
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Address: |
, |
Phone: |
1-833-235-9634 |
Provider Phone: |
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Fax: |
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Website: |
Program Website |
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ELIGIBILITY
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Eligibility
Info: |
Program offers discounts to US residents who are at or below an identified poverty line.
Patient must be diagnosed with Type 1 Diabetes.
Patient must have no insurance, or has insurance and is not enrolled in a state or government insurance plan.
Patient must be 2 years of age or older. |
Income at or below: |
Single |
|
400
% FPL |
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Couple |
|
400
% FPL |
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 |
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APPLICATION |
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Attachments
Required: |
Financial
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Physician
License #
Required: |
Not Published
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Prescriber
Signature
Allowed: |
Not Published
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Application
may be
faxed: |
Not Published
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Eligibility
determination
letter sent: |
Patient
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MEDICATION |
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Receives: |
Dexcom diabetic supplies
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Shipped To: |
Not Published
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Quantity in
Shipment: |
Not Published
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Delivery Time: |
Not Published
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Re-application
Policy: |
Must re-enroll at end of calendar year.
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Refill Policy: |
Not Published
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Other Information: |
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