| CONTACT
INFO |
|
| Address: |
, |
| Phone: |
1-844-275-2360 |
Provider Phone: |
|
| Fax: |
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Website: |
Program Website |
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| ELIGIBILITY
|
|
| Eligibility
Info: |
Access 360 can work with your health care provider to help identify your coverage and out-of-pocket costs for AstraZeneca medications. Patient Access Specialists can also connect you with affordability programs to address financial barriers.
Call program for more information on how to enroll and determine eligibility.
|
| Income at or below: |
Single |
|
% FPL |
| |
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:
|
Yes |
|
|
APPLICATION |
|
| Attachments
Required: |
Not Published
|
Physician
License #
Required: |
Not Published
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Not Published
|
|
| MEDICATION |
|
| Receives: |
Not Published
|
| Shipped To: |
Not Published
|
| Quantity in
Shipment: |
Not Published
|
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
|
| Refill Policy: |
Not Published
|
| Other Information: |
|
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