|Pharmaceutical Company||Roche Labs|
|Program Address||Medical Needs Program|
340 Kingsland St.
Nutley, NJ 07110-1199
|Toll Free Phone Number||800-285-4484|
|Alternate Phone Number||800-526-6367, 800-534-9696|
|Guidelines and Notes|
The program are not intended for clinics, hospitals, or institutions. Patients should be ineligible for any type of prescription coverage. They will only send the application to the doctor's office and the form can't be copied.
|Initiating Enrollment||The form is sent to the doctor for completion. The physician's office or a social worker may call.|
|Health Provider's Role||The doctor completes and signs the form and includes his/her DEA number. No written prescription is needed.|
|Patient's Role||Minimal information is required - they will have most of it on file. The patient's signature is required.|
|How Dispensed||The medicine is sent to the address on the doctor's DEA license.|
|Amount Dispensed||3 months|
|Estimated Response Time||3 - 4 weeks|
|Refills||Use a new application.|