Amgen Safety Net Foundation fax number

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.