CONTACT
INFO |
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Address: |
, |
Phone: |
1-800-861-0048 |
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: |
Note: This program provides screening for the Bristol-Myers Squibb Patient Assistance Foundation Patient Assistance Program.
Patients with Medicare Part D may be eligible, contact program for details.
Co-pay assistance, patient support, and patient assistance programs are available for eligible patients.
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Couple |
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% FPL |
Income at or below: |
Not
Published |
Medical expenses
can be deducted from reported income: |
No
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Social security requested on form: |
Yes |
US citizenship/residency specified:
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Yes |
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APPLICATION |
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Attachments
Required: |
Financial
|
Physician
License #
Required: |
State
NPI
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Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
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Eligibility
determination
letter sent: |
Provider
|
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MEDICATION |
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Receives: |
Medication
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Shipped To: |
Either Provider and Patient
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Quantity in
Shipment: |
Varies |
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: |
Patient or physician's office must contact the program |
Other Information: |
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