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The Assistance Fund fax number

(833) 789-1228

Patient Enrollment and Financial Assistance

Used for: Provides financial assistance for prescription co-pays and other health-related expenses through disease-program-specific funding; enrollment can be online or via paper application (paper forms available by request).

Fax destination details

Department
Patient Enrollment and Financial Assistance
Purpose
Provides financial assistance for prescription co-pays and other health-related expenses through disease-program-specific funding; enrollment can be online or via paper application (paper forms available by request).
Form
Enrollment form (online via Patient Portal) and paper enrollment form (requestable by phone). — Enrollment Application
Address
8427 Southpark Circle, Suite 100, Orlando, FL 32819, USA
Voice phone
(855) 845-3663

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Submit a completed enrollment application with required HIPAA release; wait for status; reenrollment occurs annually; paper applications available by request. See TAFCares enrollment hub and provider PDFs for details.

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