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  • Prescription And Service Request Form - Teva Cares Foundation

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INSTRUCTIONS FOR PRESCRIPTION AND SERVICE REQUEST FORMFollow these steps in order for your patient to receive support from Shared Solutions: INSTRUCTIONS FOR PRESCRIBERS Ensure patient has signed.

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Related content

Lilly Cares is a patient assistance program...
In order to provide prescription assistance to those without prescription drug coverage...
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Teva's commitment to patients provides certain Teva medications at no cost to patients in the United States who meet certain insurance and income criteria. Please click here to review the list of medications available through the Teva Cares Foundation Patient Assistance Program (PAP), or call 877-237-4881.

Patient Assistance Program If you have any questions please call the program at 877-237-4881. We are available to answer your call Monday through Friday, from 9:00am to 8:00pm Eastern Time (excluding holidays). The documents accompanying this fax transmission may contain confidential information.

The Virginia (VA) Medication Assistance Program (MAP) provides access to life-saving medications for the treatment of HIV and related illnesses for low-income clients through the provision of medications or through assistance with insurance premiums and medication co-payments.

For any urgent questions or issues, please contact our US Customer Service team directly at 888-TEVA-USA (888-838-2872) from 8:00 a.m. to 5:00 p.m. ET or email TevaCS@tevapharm.com.

Teva was established in 1901. Our global headquarters are based in Israel.

PO Box 52028, Phoenix, AZ 85072 Phone: 877-237-4881 Fax: 877-438-4404 PAGE 5 The remainder of this page is blank.

You may qualify for the Teva Cares® Foundation Patient Assistance Program if you answer “YES” to the following questions: You have a valid prescription for the product. You do not have prescription drug coverage for the product. Your household meets annual income eligibility requirements.

To be eligible, you must meet the income guidelines, which may vary by product and household size. For New Patients: Apply online through the Patient Assistance Now Oncology (PANO) program 1 800 282 7630.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232