To receive any of the products listed in the adjacent table, patient enrollment is needed.
Online enrollment is quickest. Click the Enroll Here button and follow the prompts Mail or fax is also available.
[Click here] to download the enrollment form. Mail and fax information is on the form.
30-Day Supply
$60
1 carton of 30 single use containers
90-Day Supply
$150
3 cartons of 30 single use containers
30-Day Supply
$60
1 – 5 mL bottle
90-Day Supply
$150
3 – 5 mL bottle
This product is currently out of stock
30-Day Supply
$60
1 carton of 60 single use containers
90-Day Supply
$150
3 cartons of 60 single use containers
$60
1 – 5 mL bottle
This product is currently out of stock
