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Get Verication Form For Providers

If the patient submits written information to the facility/practice that would affect the Patient Assistance Program eligibility including but not limited to revoking the consent that allows the facility/practice to provide patient information under the Patient Assistance Form the Patient Assistance Program will be notified immediately through telephone at 1-866/RX-DAPTO 866/793-2786 or fax at 1-866/4CUBIST 866/428-2478. I have pr....

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