Sublocade™ for the Treatment of Opioid Use Disorder Drug Development
Sublocade Patient Enrollment Form. Open pdf, opens in a. To enroll, please complete and send.
Sublocade™ for the Treatment of Opioid Use Disorder Drug Development
Web injection ciii enrollment form (please use black ink) prescriber’s name state license phone city, state, zip contact person phone fax dea npi xdea group/hospital. Web you have been prescribed sublocade by your treatment provider. Download and print the enrollment form. See safety info, pi & boxed warning. Ad learn about sublocade on the official product site. Flintake@curanthealth.com fax sublocade rx to: Ad download a patient enrollment form. Web how can insupport help? Ad download a patient enrollment form. Web to submit your referral/prescription:
Flintake@curanthealth.com fax sublocade rx to: Web to submit your referral/prescription: Insupport was created to provide information aimed at helping appropriate eligible patients with the process of obtaining sublocade. Access information about this chronic disease and how sublocade may help. See safety info, pi & boxed warning. Flintake@curanthealth.com fax sublocade rx to: See safety info, prescribing info & boxed warning. Web prescription & enrollment form: Open pdf, opens in a new tab or window. Web visit the insupport ® website for resources such as forms, practice and patient tools, insupport ® materials, and instructional videos to provide information on the access. Web • required sections of the patient enrollment form:
