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Form from www.needymeds.org Application for Free AstraZeneca Medicines PO Box 898, Somerville, NJ 08876 How to Complete this Application: 1. Review the information on this page carefully and keep.

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Related content

Contact Arizona Unemployment Insurance Benefits |...
Call Center Phone Numbers · Toll Free: 1 (877) 600-2722 · Phoenix: (602) 364-2722 ·...
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Contact support

Patient Assistance Program AZ&Meâ„¢ is designed to help qualifying people without insurance and those on Medicare who are having trouble affording their AstraZeneca medications. Learn more.

TEL: 800-292-6363.

If you are in the United States and would like additional information regarding AstraZeneca products, or you are a third party with an offer of services for AstraZeneca, you can contact the AstraZeneca Information Center by phone at 1-800-236-9933 (Monday-Friday, 8am-8pm ET, excluding holidays).

If you are enrolled in Medicare Part D, you may be eligible for the program if you meet the following criteria: 1. Enrolled in Medicare Part D; 2. You are an individual with an annual income at or below $35,000, or if a couple, at or below $48,000; 3.

completed, sign and fax to 1-877-239-0867 with AZ&ME Provider Form. Both forms must be received to determine eligibility.

You may be eligible if you meet the following criteria: 1. You have an annual household income* at or below: $35,000 for a single person $48,000 for a family of two $60,000 for a family of three $70,000 for a family of four $80,000 for a family of five * Income limits may be higher in Alaska and Hawaii.

The Arizona Rx Card is offered to Arizona residents of any age or income level to lower the cost of both brand-name and generic prescription medications. It can save you as much as much as 80% on the cost of your prescriptions.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232