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      Patient Assistance Program Center

Program Details

Amneal Patient Assistance Program

Zomig (tablets) (zolmitriptan)
Address: PO Box 220586
Charlotte, NC , NC 28222
Phone: 1-877-764-9021 Provider Phone:
Fax: 1-877-764-9022 Website: Program Website
Eligibility Info:
  • Patient must not have affordable coverage for the prescription.
  • Patient must meet program income guidelines which are not disclosed.
  • Patients with Medicare Part D should contact the program for more information.
  • 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
    Attachments Required: Financial
    Physician License #
    Either DEA or State
    Prescriber Signature
    Application may be
    Eligibility determination
    letter sent:
    Both Provider and Patient
    Receives: Medication
    Shipped To: Patient
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: New application every 12 months
    New financial information every 12 months
    Program will send an application for renewal when patient's enrollment is due to expire.
    Refill Policy: Not Published
    Other Information:

    Last Updated: 09/18/2023




    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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