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 |
90-Day Supply |
 $601 carton of 30 single use containers |
$1503 cartons of 30 single use containers |
 $601 - 5 mL bottle |
$1503 - 5 mL bottle |
 $601 carton of 60 single use containers |
$1503 cartons of 60 single use containers |
$601 - 5 mL bottle |
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