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HCP Sample Request | Novartis US

Health Care Professional Sample Request Form . After submitting your request, you may continue to edit HCP and sample information, and submit the form again. Thank you for your interest in Novartis Pharmaceuticals Corporation. Your request has been successfully submitted.



SAMPLE REQUEST FORM Dear Healthcare Professional: Thank you for requesting samples from Kowa Pharmaceuticals America, Inc. To receive samples of LIVALO® (pitavastatin) tablets, please take a moment to complete the bottom section of this form, sign and scan/email to [email protected] or fax to


Bayer Consumer Health - home

The information on this site is intended for healthcare professionals in the United States and is not intended for the general public.


Noven Therapeutics, LLC. Women’s Health Sample Request

Sample Request Form Fax to 1-877-540-6497 Noven Therapeutics, LLC. Women’s Health Practitioner’s Last Name First Name (required) Professional Designation State License Number (required) Expiration Date(required) Office Address(required-PO boxes are not accepted) City (required) State (required) Zip (required)


Sample Request Form Mylan Inc. USE ONLY

This sample request form is only valid until 6/30/2019. Expired forms will not be processed. Sample Request Form FAX TO: Mylan Specialty L.P. Attn: Customer Relations FAX #: 1-304-285-6418 Healthcare Professional (HCP) Sample Request Form for:


Nutricia HCP

Customers in Northern Ireland should visit Nutricia.ie to order samples online. Orders are limited to 2 different products per order. We would recommend you allow 2-3 working days for delivery. If you prefer not to order online, please print out this form to order ONS samples or print out this form to sample from our pre-thickened range.


PREMARIN® (conjugated estrogens) Vaginal Cream Samples

Select samples or Co-pay Card (based on eligibility*) Enter medical office shipping address . Confirm request. Electronically sign, † or print and fax back your request form *Not all Pfizer products are available for sampling through this website. After you log in, sample selections will appear based on eligibility.


Fax Form - allerganresources.allerganaccess.com

samples will not be forwarded. By signing this form, I request the drug samples listed herein and certify that I am a licensed practitioner currently authorized under applicable federal and state law to request, receive, and dispense these drug samples. I also certify that I have requested these samples for the legitimate medical needs of my

https://allerganresources.allerganaccess.com/~/media/Unique Sites/Andameds/pdf/loloestrin/SampleRequestFormLoLoestrin.ashx

Request Samples, Vouchers, and/or Coupons

Available samples are shipped as soon as the appropriate authorization has been received. Eligible, validated MDs, DOs, and other licensed practitioners (depending on state-level requirements) can expect to receive samples within 3–5 business days of Merck receiving the signed and dated Sample Request Form. Assistance with sample requests


Novartis® Pharmaceuticals for Health Care Professionals

We’re moving on! Join us at www.hcp.novartis.com —our new location for health care professionals to find product, access, and medical information. Now you can find the tools you need to help manage your patients, all in one place! You’ll have access to the site in a moment, or click continue to close this message and advance directly to the site.


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