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. Respiratory Medication
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The MASH Respiratory Medication Program is a specialized mail-order prescription service which supplies unit dose medications to patients at home. The convenience of our program and integration with respiratory equipment is the main features of our program. Each month your medication and supplies will be shipped via UPS directly to your doorstep! That's right, no traveling or waiting in line at the pharmacy. Plus, we will handle all the paperwork with your physician and insurance company. Once you've started using our service, you'll be glad you did.

Did you Know...

      Click Here for Information on the NEW PARI Trek            Click Here for Information on BUBBLES The Fish                      Medicare and/or your insurance may pay for your respiratory medications, supplies, and equipment.

  • No up-front expense*
  • No Medicare or insurance claim forms to complete
  • No waiting for reimbursement
  • No additional charge for shipping
* Co-payments and deductibles will apply

If needed, MASH will provide you with a nebulizer/compressor with your initial order.  Detailed printed instructions are included for the operation of  the equipment.  However,  we are never more than a phone call away, 24 hours a day, 7 days a week if you need additional assistance.

Easy To Use...

Medications arrive precisely measured and packaged in single-dose vials. All you have to do is to break open a vial and pour the contents into your nebulizer "cup." There is no need for you to carry multiple bottles or measuring devices. No more spills and wasting of expensive medicine. Our unit dose medication program is both convenient, safe and cost-effective.

To Sign-up for our program,  simply fill out the Sign-Up form below or call our office at (800) 768-9182 if you have additional questions. 

Benefits Of Program    

  • Medications in unit dose (No mixing)

  • Free, prompt delivery & instruction on use of Nebulizer / Compressor machine

  • Administration Sets included with each order

  • Medications shipped directly to your door each month

  • Emergency Service available 24 hours, 7 days weekly

  • Most popular brands including Albuterol Sulfate, Ipratropium Bromide, Atrovent and many more.
Sign-up  Take a moment to sign up for the MASH Respiratory Program.  Complete the necessary form to get started today on the road to better health. We will begin processing your order the same day.  Please fill out the form completely, missing information will delay your order.  We will review your information and contact your physician and  insurance provider to obtain additional information.  Note:  If your insurance provider is a HMO please call (800)768-9182 for coverage verification.
    Patient Registration      
     
First Name: Middle Name: Last Name:
Referred By:
Referral Company Name   (HME Providers Only)
Email Address:
Address:
City: State: ZIP:
Home Phone: Work Phone: Fax:
Date of Birth: Social Security Number:
Height: Weight:
Sex:
Marital Status: Employment:

    Medical Information      
     
Primary Insurance Company
ID #: Group #:
Insured Person: Relationship:
Secondary Insurance Company
ID #: Group #:
Insured Person: Relationship:
Diagnosis or Diagnosis Code(s):   (Hold Ctrl Key and Click all that applies)  
 
     
Do you currently use Nebulizer Equipment?   
Type Model of Equipment:     (If yes above, required Info to Ship Supplies)   
 
Nebulizer Equipment Serial Number:     
 
   
Name of Doctor: 
Address of Doctor: 
 
City / State and Zipcode of Doctor: 
Doctor Phone: Doctor Fax:  (Needed to process order)

By completing this form, you are authorizing a MASH Pharmacy representative to   contact you.

                           

 

 

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