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Get Frmnov301 Novartis Pap Mm Application And Instructions 1.... - My Clevelandclinic

T RECENT FEDERAL TAX RETURN. If the patient does not file taxes, please attach other proof of annual income. ATTACH AN ORIGINAL PRESCRIPTION up to a maximum 3-month supply of a sanofi-aventis U.S. brand name product you are requesting. Mail or fax application, prescription, and photocopy of Federal income tax return to the following address: sanofi-aventis U.S. Patient Assistance Program P.O. Box 759 Somerville, NJ 08876 Fax#: (866) 734-7372 Please allow 4 weeks for processing and delivery.

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