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Get and Sign Teva Cares Foundation Application Form

Get and Sign Teva Cares Patient Assistance Program Form

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Terminate this Program at any time without prior notice and reserves the right to recall the product when necessary. I promise that I have not received and will not seek to receive insurance reimbursement for any drug I request or receive as part of the TEVA CARES FOUNDATION Patient Assistance Program. I understand that I can withdraw from the Program at any time by notifying THE FOUNDATION in writing at the address above. Each application will be considered on a case by case basis. Income...
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