Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

Mission Product Request

For Healthcare Professionals Only

Provided by: Mission Pharmacal Company


TEL: 877-425-0325


ALT PHONE: 800-531-3333
FAX: 877-426-2795
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Mission Product Request: Contact program

 

Brand Name Medications Covered

 
  • Aquoral spray
  • Hyophen
  • Avar Family Products topical
  • Keralac cream
  • Binosto
  • Lithostat tablet
  • CitraNatal 90 DHA tablet
  • Ovace Plus Products topical
  • CitraNatal Assure tablet
  • Plexion
  • CitraNatal B-Calm tablet
  • Texacort solution; topical
  • CitraNatal Harmony capsule; gel
  • Tindamax tablet
  • Eletone cream
  • Uribel capsule
  • Ferralet 90 tablet
  • Urocit-K
  • Flowtuss solution
  • Utira-C
  • Hycofenix solution
 

Generic Name

 
  • acetohydroxamic acid tablet
  • methenamine/sodium phosphate/monobasic/monohydrate/phenyl salicylate capsule
  • alendronate sodium
  • potassium citrate
  • artificial saliva spray
  • prednisolone sodium phosphate
  • dual-iron tablet
  • sodium sulfacetamide topical
  • dual-iron/DHA tablet
  • sodium sulfacetamide/sulfur
  • emolent cream
  • sulfacetamide/sulfur topical
  • hydrocodone bitartrate/guaifenesin solution
  • tinidazole tablet
  • hydrocodone bitartrate/pseudoephedtine/guaifensesin solution
  • urea cream
  • hydrocortizone solution; topical
  • vitamin/mineral supplement capsule; gel
  • methenamine/benzoic acid/phenyl salicylate/methylene blue/hyoscyamine sulfate
  • vitamin/mineral supplement tablet
  • methenamine/sodium phosphate monobasic/phenyl salicylate/methylene blue/hyoscyamine sulfate
 

Eligibility Requirements   

Insurance Status Not specified
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria Not disclosed
US Residency Required? Not specified
   

Application

Obtaining The Doctor should call for an application or download it from the website
Receiving Faxed to Doctor's office
Returning Fax from Doctor's office
Doctor's Action Complete section and sign
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Doctor notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Doctor's office
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Doctor contacts company
   

Additional Information

Resources for HEALTHCARE PROFESSIONAL ONLY.
The Doctor must contact the program to place an order.


Updated September 21, 2017