Sponsorships requests. Links are provided as a public service and for informational purposes only. %%EOF Educational Grants, Community and Patient Health Education, Charitable Novo Nordisk will retain the data consistent with Novo Nordisk’s data retention policies and as long as required by law. `�*�|���X��t������1 �-���Z :����Q�T�U�ۂ��4�N�m 8亮��C懚��-���]��:CtK�K�������O�u�HЩ���f����HŜ��-��� ��#��^��Y��@��o�Y�wfĵ��")�\� \��u�p���W��`�~&t6�8�:WX^Yq�/��/�@q?&���{�S��*u���y�/5Їwi0�"U�~���v �~Z��c*� �.���dy [�;�+�U��;�c�=G�R;�&C The site is restricted to the submission of HCP Note: Applicants chosen as finalists will be required to provide confirmation of diabetes from their physician. applicable data protection legislation. If you do not wish to complete the form below, you may choose to mail or email a printed application to: NOVO NORDISK DONNELLY AWARDS 2204 Larkdale Drive Glenview, IL 60025 dmdstone@comcast.net Be sure to include the required attachments: 1. any Novo Nordisk Diabetes PAP medication towards the applicant’s True-Out-Of-Pocket (TrOOP) costs. Alternately, please email the essay to dmdstone@comcast.net.Attach 2 recommendations from people who know the applicant commenting on the applicant’s achievements, values, commitment, sportsmanship, and/or community service. care with established high-quality standards.The Novo Nordisk Grants Management System allows you to register and Novo Nordisk will retain the data consistent with Novo Nordisk’s data retention policies and as long as required by law. The Patient Assistance Program provides medication at no cost to those who qualify.Patients who are approved for the PAP may qualify to receive free diabetes medicine from Novo Nordisk.
I also understand that eligibility under the PAP is subject to Novo Nordisk’s discretion and that Novo Nordisk reserves the right to modify or terminate the PAP at any time. Novo Nordisk will retain the data consistent with Novo Nordisk’s data retention policies and as long as required by law. If approved, your medicine will be sent to your health care provider’s office, where you can pick it up.Product availability subject to change without notice.Novo Nordisk reserves the right to modify or cancel this program at any time without notice.It's important to properly dispose of your used Novo Nordisk products.Find tools and resources tailored to your needs at Cornerstones4Care.com.Clicking “continue” below will take you to a website to which our Privacy Policy does not apply.
Alternately, please email the recommendations to dmdstone@comcast.net.I acknowledge and declare by checking this box that the information reported on this form, to the best of my knowledge and belief, is true, correct, accurate and complete.I acknowledge and declare by checking this box that the information reported on this form, to the best of my knowledge and belief, is true, correct, accurate and complete.Please complete the online form below to submit your answers. Faxes must be sent from your health care provider’s office Community and Patient Health Education, Charitable Giving and
There is no registration charge or monthly fee for participating.If you have lost your health insurance coverage because of a change in job status due to COVID-19, you may be eligible for a free 90-day supply of insulin. If the applicant qualifies under the Novo Nordisk Diabetes PAP guidelines, up to a 120-day supply of the For avoidance of doubt, “data protection legislation” means the law governing the Novo Nordisk Corporate Headquarters, Tel: +45 4444 8888, Novo Nordisk A/S, Novo Allé, 2880 Bagsvaerd, Denmark Complete the "For Health Care Practitioner" section of the application, including “Order information” (subsection D) Sign and date the application; Fax the completed application and proof of income to 1-866-441-4190, or mail them to Novo Nordisk Inc., PO Box 370, Somerville, NJ 08876. Phone: +45 3527 6600 Fax: +45 3527 6601. Two recommendations DEADLINE for APPLICATION Must be received by June 1, 2020. endstream endobj startxref Their diabetes has taught them to be disciplined and to stay in top physical shape.If you do not wish to complete the form below, you may choose to mail or email a
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