How To Order

walgreen copay assistance Click here

1. You must have a licensed Physician in the United States write a prescription and send it to a US Licensed Pharmacist (Walgreens and Walmart Specialty Preferred

Walmart Specialty
9600 Parksouth Court East,
Suite 120
Orlando, FL 32837

Call 1-877-453-4566

Fax 1-866-537-0877

Email specialty@walmart.com

). Healthcare Professionals Click Here for Prescribing and patient Information. Work with one of the pharmacies indicated on this page or have your pharmacist call us. We sell directly to hospitals as well as vets.
2. Any US licensed Pharmacist can order directly by following the directions below. (Regular or Specialty pharmacist) DOES NOT NEED TO BE A SPECIALTY PHARMACY
3. If you are a patient talk to your Physician. If you are having trouble obtaining the prescription or reimbursement - Contact Us here as we may be able to help. It will be very common that your pharmacy is unfamiliar with this medication and may think they cant order. They can. Just call us for assistance.

Information Walgreens

Hospital Consignment Program Information

Pharmacist Directions:

Pharmacist Directions

*Product will be shipped overnight (If you need sooner or have additional questions, please call 908-635-2326) (PAM cases ALWAYS call as soon as possible)

(1)Call 908-635-2326 (ALTERNATE PHONE 407-270-7790 ). or Send an Email to Todd@profounda.com and copy to tara@profoundahb.com with:

(1) Your contact information (email/phone)

(2) a Copy of your State Pharmacy License. (3) a copy of your Purchase Order (PO)#

(3) the indication if you know it

Rx is one 50 mg capsule TID for 28 days (TOTAL 84 capsules). Take with Food.
Capsules are blister packed into 28 capsules per pack (3 packs needed for typicall 28 day dose of 84 capsules) NDC# 69051-300-01

(2) Or Fill out this Order Form and we will contact you:

Impavido is NOT sold through wholesalers but can be sold to ANY licensed pharmacy (Specialty, Hospital or Regular pharmacy can order directly from Profounda)

DOES NOT NEED TO BE A SPECIALTY PHARMACY

For Walgreens and Walmart pharmacies, please see below

Have Questions? Need help with Reimbursement? Get someone to call you by filling out this form or call 908-635-2326 to reach us immediately:

DO NOT USE THIS FORM IN CASES OF EMERGENCY.

Not Available at CVS

Walgreens Directions:

Walmart Directions:

walgreens pharmacy

(1) Impavido is ordered at Walgreens by the pharmacist sending email to Rxinventory@walgreens.com when you have a paid claim.

Rx is one 50 mg capsule TID for 28 days (TOTAL 84 capsules). Take with Food.
Capsules are blister packed into 28 capsules per pack (3 packs needed for 84 capsules) NDC# 69051-300-01

(2) Any issues with Co-pay Insurance or if patient assistance is needed, contact Profounda at 908-635-2326.

(3) Product is shipped for Next Day Delivery.

Have Questions? Get someone to call you by filling out form above or call Profounda at 908-635-2326.

Here's the step-by-step language to use when processing the prescription with the secondary payment.

Connecting the Copay Card with Primary Coverage

Enter the PROFL billing information and press "OK"
(On the prescription entry screen) Press Custom Payment Order
Select PROFL and place a Y in the COB field
Press "OK"
Select Options
Third Party Authorization
(At the top, make sure to select the second tab "COB" - not the primary insurance window) In the Submission clarification (Rx Denial) field: 99-other
Press "Ok"
Press "Update Fill"

If an SDL (Submit Direct Link) is required:

Bill the Claim through Primary Insurance and "Cash out" the secondary insurance.
Open WebSDL - (Application - Submit direct Link
Select PROFL
Click Third Party Authorization
In the Submission clarification (Rx Denial) field: 99-other
Press "Ok"
Press COB/OtherCov
Press "Ok"
Press "Submit"

(1) Impavido is dispensed from Walmart Specialty Pharmacy to the patient. To place an order, Walmart pharmacy associates may call 877-453-4566 or send an email to specialty@walmart.com

● Rx is one 50 mg capsule TID for 28 days (TOTAL 84 capsules). Take with Food.

● Capsules are blister packed into 28 capsules per pack (3 packs needed for 84 capsules) NDC# 69051-300-01

(2) If patients need assistance with copayments, insurance, etc. please contact Profounda at 908-635-2326.

(3) Product is shipped for Next Day Delivery.

Have Questions? Get someone to call you by filling out the form above or calling Profounda at 908-635-2326.

Store #17736

IMPAVIDO

(miltefosine)

*U.S. residents only

®

How to Order

walgreen copay assistance Click here

1. You must have a licensed Physician in the United States write a prescription and send it to a US Licensed Pharmacist (Walgreens and Walmart Specialty Preferred

Pharmacist Directions:

*Product will be shipped overnight (If you need sooner or have additional questions, please call 908-635-2326) (PAM cases ALWAYS call as soon as possible)

(1)Call 908-635-2326 (ALTERNATE PHONE 407-270-7790 ). or Send an Email to Todd@profounda.com and copy to tara@profoundahb.com with:

(1) Your contact information (email/phone)

(2) a Copy of your State Pharmacy License. (3) a copy of your Purchase Order (PO)#

(3) the indication if you know it

Rx is one 50 mg capsule TID for 28 days (TOTAL 84 capsules). Take with Food.

Capsules are blister packed into 28 capsules per pack (3 packs needed for typicall 28 day dose of 84 capsules) NDC# 69051-300-01

(2) Or Fill out this Order Form and we will contact you:

Have Questions? Need help with Reimbursement? Get someone to call you by filling out this form or call 908-635-2326 to reach us immediately:

DO NOT USE THIS FORM IN CASES OF EMERGENCY.

Not Available at CVS

Walgreens Directions:

Walmart Directions:

(1) Impavido is ordered at Walgreens by the pharmacist sending email to Rxinventory@walgreens.com when you have a paid claim.

Rx is one 50 mg capsule TID for 28 days (TOTAL 84 capsules). Take with Food.

Capsules are blister packed into 28 capsules per pack (3 packs needed for 84 capsules) NDC# 69051-300-01

(2) Any issues with Co-pay Insurance or if patient assistance is needed, contact Profounda at 908-635-2326.

(3) Product is shipped for Next Day Delivery.

Have Questions? Get someone to call you by filling out form above or call Profounda at 908-635-2326.

(1) Impavido is dispensed from Walmart Specialty Pharmacy to the patient. To place an order, Walmart pharmacy associates may call 877-453-4566 or send an email to specialty@walmart.com

● Rx is one 50 mg capsule TID for 28 days (TOTAL 84 capsules). Take with Food.

● Capsules are blister packed into 28 capsules per pack (3 packs needed for 84 capsules) NDC# 69051-300-01

(2) If patients need assistance with copayments, insurance, etc. please contact Profounda at 908-635-2326.

(3) Product is shipped for Next Day Delivery.

Have Questions? Get someone to call you by filling out the form above or calling Profounda at 908-635-2326.

IMPAVIDO

(miltefosine)

*U.S. residents only

How to Order

walgreen copay assistance Click here

1. You must have a licensed Physician in the United States write a prescription and send it to a US Licensed Pharmacist (Walgreens and Walmart Specialty Preferred

Pharmacist Directions:

*Product will be shipped overnight (If you need sooner or have additional questions, please call 908-635-2326) (PAM cases ALWAYS call as soon as possible)

(1)Call 908-635-2326 (ALTERNATE PHONE 407-270-7790 ). or Send an Email to Todd@profounda.com and copy to tara@profoundahb.com with:

(1) Your contact information (email/phone)

(2) a Copy of your State Pharmacy License. (3) a copy of your Purchase Order (PO)#

(3) the indication if you know it

Rx is one 50 mg capsule TID for 28 days (TOTAL 84 capsules). Take with Food.

Capsules are blister packed into 28 capsules per pack (3 packs needed for typicall 28 day dose of 84 capsules) NDC# 69051-300-01

(2) Or Fill out this Order Form and we will contact you: ​

Have Questions? Need help with Reimbursement? Get someone to call you by filling out this form or call 908-635-2326 to reach us immediately:

DO NOT USE THIS FORM IN CASES OF EMERGENCY.

Not Available at CVS

Walgreens Directions:

Walmart Directions:

(1) Impavido is ordered at Walgreens by the pharmacist sending email to Rxinventory@walgreens.com when you have a paid claim.

Rx is one 50 mg capsule TID for 28 days (TOTAL 84 capsules). Take with Food.

Capsules are blister packed into 28 capsules per pack (3 packs needed for 84 capsules) NDC# 69051-300-01

(2) Any issues with Co-pay Insurance or if patient assistance is needed, contact Profounda at 908-635-2326.

(3) Product is shipped for Next Day Delivery.

Have Questions? Get someone to call you by filling out form above or call Profounda at 908-635-2326.

(1) Impavido is dispensed from Walmart Specialty Pharmacy to the patient. To place an order, Walmart pharmacy associates may call 877-453-4566 or send an email to specialty@walmart.com

● Rx is one 50 mg capsule TID for 28 days (TOTAL 84 capsules). Take with Food.

● Capsules are blister packed into 28 capsules per pack (3 packs needed for 84 capsules) NDC# 69051-300-01

(2) If patients need assistance with copayments, insurance, etc. please contact Profounda at 908-635-2326.

(3) Product is shipped for Next Day Delivery.

Have Questions? Get someone to call you by filling out the form above or calling Profounda at 908-635-2326.

(2) Or Fill out this Order Form and we will contact you: