CONTACT
INFO |
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Address: |
, |
Phone: |
1-800-652-6227 |
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: |
Hospitals can apply for this program if they're currently enrolled in the 340B Drug Pricing Program, which requires drug manufacturers to provide outpatient medications at reduced prices. To apply, hospitals must also be classified as a Disproportionate Share Hospital (a hospital that treats patients who don't have insurance or aren't eligible for other health care coverage).
Hospitals can apply online via the HAPAP Portal: http://www.jjpaf.org
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Couple |
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% 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:
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Not
Published |
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APPLICATION |
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Attachments
Required: |
Not Published
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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: |
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MEDICATION |
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Receives: |
Medication
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Shipped To: |
Hospital
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Quantity in
Shipment: |
Not Published
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Delivery Time: |
Not Published
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Re-application
Policy: |
New application every 12 months
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Refill Policy: |
Not Published
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Other Information: |
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