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I agree to pick up JANUVIA at the above Pharmacy. (Prescription will not be valid at any other pharmacy)
Please confirm that you have read "Understanding Retail Pick Up". Click Here To Download PDF
Please confirm that you have read "Understanding Mail Order Pharmacy". Click Here To Download PDF
I hereby authorize ImpaxRx and its authorized agents/entities to contact me regarding the Prescription Assistance Program (PAP) by mail, email, phone and/or text.
I understand and agree that my mailing address, telephone number, cellular phone number, email address any other electronic address I provided or may provide in the future to ImpaxRx is my private information and will not be shared, bartered, sold or any way used by ImpaxRx without my authorization.
Thank you for your interest in our Prescription Assistance Program (PAP). You have indicated that you wish to submit a request for Prescription Assistance for your current medication JANUVIA
Additional information may be required during your application process. An Rx specialist will contact you by phone and email to assist you with our PAP application/enrollment process and will answer any question you have.
Your completed PAP request will be sent to your physician for their approval.
After submission, you will be contacted in 48 hours by a PAP representative. Please note that the PAP process can take up to 30 days to qualify. If you need medication immediately, please order until you are approved.
I authorize RxManage and its agents and entities authorized by RxManage to contact me for International Pharmacy Program (IPP) administrative and advocasy services at any of my following : mailing address, telephone number, cellular phone number, email address or any other electronic address I provided or may provide in the future to RxManage.
I understand and agree that my mailing address, telephone number, cellular phone number, email address any other electronic address i provided or may provide in the future to RxManage is my private information and will not be shared, bartered, sold or any way used by RxManage with any agents or entities not referenced above without my authorization.
Thank you for your interest in participating in our International Pharmacy Program (IPP). You have indicated that you wish to submit a request for Prescription Assistance for your current medication JANUVIA
Additional information may be required during your application process. An Rx specialist will contract you by phone and email to provide assistance and coordination through our RxManage application/enrollment process and will answer any question you have.
Your completed RxManage request will be sent to your physician for their approval. Please download and/or print a copy of a RxManage request confirmation for your records as this will include additional information for you and your physician.
After submission, you will be contacted in 48 hours by a RxManage representative. Please note that the RxManage process can take up to 30 days to qualify. If you need medication immediately, please order until you are approved.
Please select quantity.
Order by phone855-798-2538
This a Pharmacy Subscription Service. THIS IS NOT INSURANCE. We provide you direct access to medications at negotiated PBM pricing, and Home Delivery Pharmacy pricing on a pre-paid basis. Clever RX offers solutions for high priced specialty drugs via an International Pharmacy or PAP service. In addition, a discount pharmacy solution is available, were you search discount options and are directed to a specific pharmacy for super low pricing. Sometimes, this can be your lowest price option.
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