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 Special Needs Assistance Request Form 2012

Special Needs Assistance for Seniors Request 2012-2025 Form

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Instructions and help about Special Needs Assistance Request Form

at Merck we believe no one should go without the medicines they need that is why the company provides certain medicines and adult vaccines free of charge to people who do not have prescription drug or health insurance coverage and who without our assistance cannot afford their Merc medicines and vaccines enrolling in The Merck patient assistance program is free you can enroll through the mail using our paper enrollment form this short video will explain how to determine eligibility and fill out the paper enrollment form to download the enrollment form go to merckhelps.com and select your medication's name from the products listed on the right side of the home page then on the product page for your medication follow the steps to check your eligibility and download the enrollment form you can also call 800-727-5400 to request an application medicines or adult vaccines distributed Through The Merck patient assistance program are free of charge for all eligible patients you may qua

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