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Amgen Safety Net Foundation fax number
(844) 465-1384
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Replacement Requests
Used for: Submitting replacement medication requests for enrolled Foundation patients; approved replacements are shipped monthly to the facility and a shipping manifest is faxed to the facility.
Fax destination details
- Department
- Replacement Requests
- Purpose
- Submitting replacement medication requests for enrolled Foundation patients; approved replacements are shipped monthly to the facility and a shipping manifest is faxed to the facility.
- Form
- Replacement Request Form — Replacement Request Form for Amgen Safety Net Foundation (BLINCYTO and IMDELLTRA)
- Address
- 2730 S. Edmonds Lane, Suite 300, Lewisville, TX 75067
- Voice phone
- 1-888-401-4931
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Submit this replacement request with required facility and patient information, enrollment verification, and the patient administration records as applicable; the prescribing physician must attest; shipments are issued to the facility address on file and a shipping manifest will be faxed to your facility.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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