Aciphex (rabeprazole)

Program name: Aciphex Patient Assistance Program

Program address: PO Box 220458 Charlotte, NC 28222-0458

Phone number: 800-523-5870

Fax number: 800-526-6651

Forms: aciphe0238.pdf

Eligibility guidelines
and notes: The patient can have no public or private prescription insurance and

Application process: With the patient's permission, anyone concerned can call for an application.

Application requirements: The doctor must fill out a section and sign the application.

Program details: The medication is sent to the doctor's office.

Last updated: 8/6/2008

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