To download a free Order Enrollment Form for Prescription Assistance.
We encourage social workers, medical professionals, and advocate groups to contact us for a free supply of enrollment forms.
Here's how to get in touch with us:
By mail: Generic Medicine Program
P. O. Box 125
Doniphan, Mo. 63935-0125
To access the Generic Medicine Program Patient Assistance Program helpdesk by phone, you can call toll-free, 1-800-939-7894.
Fax Enrollment Order Form Toll-Free 24 hours 7 days a week to: 1-888-812-5170.