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      Patient Assistance Program Center

Program Details

Here to Help Patient Assistance Program

Suboxone Sublingual Film (buprenorphine and naloxone)
Address: PO Box 220281
Charlotte, NC 28222-0281
Phone: 1-888-898-4818 Provider Phone:
Fax: 1-888-407-9788 Website: Program Website
Eligibility Info:
  • Patient must not have public or private insurance.
  • Patient must be at least 16 years old.
  • Physician can only have 3 patients on the program at a time.
  • Income at or below: Single 250 % FPL
      Couple 250 % FPL
    Federal Poverty Level Calculator Federal Poverty Level Calculator
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Not Published
    US citizenship/residency specified: Yes
    Attachments Required: Financial
    Physician License #
    Prescriber Signature
    Application may be
    Eligibility determination
    letter sent:
    Both Provider and Patient
    Receives: Pharmacy Card
    Shipped To: Patient
    Quantity in Shipment: 30 days
    Delivery Time: Not Published
    Re-application Policy: Upon approval, eligible for 12 months. No renewal.
    Refill Policy:
    Other Information:

    Last Updated: 03/08/2018




    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


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