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Program Details

VIATRIS, INC.
EpiPen4School Program

EpiPen Jr (epinephrine)
 
CONTACT INFO
Address:
,
Phone: 1-973-845-7600 Provider Phone:
Fax: Website: Program Website
ELIGIBILITY
Eligibility Info:
  • For grades K through 12 licensed as an educational facility under all applicable laws. See Free Certification Form for additional information.
  • 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: Not Published
    APPLICATION
    Attachments Required: Not Published
    Physician License #
    Required:
    Not Published
    Prescriber Signature
    Allowed:
    Not Published
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Not Published
    MEDICATION
    Receives: Medication
    Shipped To: School Nurse
    Quantity in Shipment: Varies
    Delivery Time: Not Published
    Re-application Policy: Contact program for details.
    Refill Policy: Replenishment form must be completed.
    Other Information:

    Last Updated: 03/15/2024

     

     

     


    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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