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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Advanced Vision Research |
| Program Name |
Nutridox Patient Assistance Program |
| Program Address |
PO Box 5836
Somerset, NJ 08875
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| Phone Number |
800-589-0840
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| Fax Number |
732-507-7635 |
| Medications on Program |
None |
| Application Forms |
Nutridox Application
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On-line Application
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No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient can have no public or private prescription insurance and and have a household income of or less than 300% of FPL. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident.
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| Application Process |
The doctor or patient can call to request an application. The application is sent to either the doctor or the patient. The completed application can be faxed or mailed back.
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| Application Requirements |
The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income.
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| Program Details |
Up to a 90-day supply is sent to the doctor's office.
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| Last Updated |
June 08, 2009 |
