Patient Assistance Program – prescription coverage
November 21st, 2009
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Patient Assistance Program
PO Box 66552
St. Louis, MO 63166-6552
1-800-830-9159 Phone 1-800-497-0928 Fax Monday – Friday 7:30 am – 5:00 pm CT
Online At www.tpna.com select-Responsibility select-Patient Assistance Program
Qualifications for eligibility
1- You are a resisident of the United States 2- You have no prescription coverage through private or government programs ( Medicare Part D eligable and enrolled applicants will be considered under certain circumstances.) 3- Your total income does not exceed:
2009 FEDERAL POVERTY CHART (300%) # of Persons in Family Annual Income Household 1 $32,490.00 2 $43,710.00 3 $54,930.00 4 $66,150.00 5 $77.370
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