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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Mission Pharmacal Company |
| Program Name |
Mission Pharmaceutical Patient Assistance Program |
| Program Address |
Customer Services
PO Box 786099
San Antonio, TX 78278-6099 |
| Phone Number |
800-292-7364
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| Fax Number |
800-681-4050 |
| Medications on Program |
Lithostat Tablets (acetohydroxamic acid)
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| Application Forms |
Not Applicable |
On-line Application
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No on-line application available at this time |
| Web Site |
No link available. |
| Eligibility Guidelines and Notes |
The patient must have no insurance and be financially unable to afford the medication. Medical diagnosis necessary for this program is not specified. The patient must also be a US citizen. Lithostat is on backorder.
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| Application Process |
The doctor's office needs to send a letter indicating that patient needs this medication, duration, diagnosis, patient name, contact name, phone and fax numbers. The application is sent to the doctor's office. The completed application must be faxed or mailed from the doctor's office.
The doctor is notified of acceptance or denial.
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| Application Requirements |
The doctor must fill out a section, sign the application and attach a prescription. The patient must fill out a section and sign the application.
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| Program Details |
Up to a 90-day supply is sent to the doctor's office. A copy of the letter with new dates and any change in dosage needs to be sent by the doctor's office at least 3 weeks prior to the prescription running out. In some cases a new application may be needed.
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| Last Updated |
November 17, 2009 |
