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Program Details

AMNEAL PHARMACEUTICALS, LLC.
Amneal Patient Assistance Program

Zomig (tablets) (zolmitriptan)
 
CONTACT INFO
Address:
,
Phone: 1-877-764-9021 Provider Phone:
Fax: Website: Program Website
ELIGIBILITY
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
    APPLICATION
    Attachments Required: Not Published
    Physician License #
    Required:
    Either DEA or State
    Not Published
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Both Provider and Patient
    MEDICATION
    Receives: Medication
    Shipped To: Patient
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: Not Published
    Refill Policy: Not Published
    Other Information:

    Last Updated: 09/12/2024

     

     

     


    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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