The information contained in this section of the site is intended for US health care professionals and specialty pharmacy representatives only. Click “OK” if you are a health care professional or specialty pharmacy representative.
This form is used to initiate the check reimbusement process. It is completed by the practice or pharmacy.
This form is used to initiate the EFT registration process. It is a one-time registration completed by the practice.
This form is used to initiate the check reimbursement process. It is a one-time registration completed by the practice.
This form is used by the practice to give consent to receive fax communications from Genentech, Inc.
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