Potaba Patient Assistance Program

Glenwood, LLC

Contact Information
19 Empire Blvd
PO Box 1508
So Hackensack, NJ 07606
1-(800) 542-0772 (phone)
1-(201) 221-0060 (fax)
How to Apply:
Select one of the links below to download the application or go to the program site for more information on how to apply. Once you fill out your application, send it to the address on the application. Do NOT send it to RxResource.