By clicking “I agree/submit” below, the entity name above agrees as follows:

By clicking “Submit Changes” below, the entity name above agrees as follows:

By clicking below you certify you have the authority from the site owner to remove this site from the website:

Terms and conditions:

By registering your treatment site on the Amgen Rare Disease Infusion Site Locator^™, sites must be willing to accept faxed medical orders and insurance coverage information, accept a call from a patient making an infusion appointment, purchase and administer KRYSTEXXA^®, TEPEZZA^®, and/or UPLIZNA^®, and bill the appropriate insurance company through the patient’s insurance plans. Entities that enroll in the Amgen Rare Disease Infusion Site Locator™ treatment site locator must not be listed on any federal exclusion or debarment lists (such as the OIG’s List of Excluded Individuals/and Entities on the Excluded Parties List). Choices provided are based on proximity to the patient/provider requesting assistance and/or criteria provided by the requesting provider/patient.

Participation Authorization:

The entity named above understands the terms and conditions above for listing the treatment site in the Amgen Rare Disease Infusion Site Locator^™, and that those terms and conditions are subject to change without notice. The entity named above certifies that it has the appropriate licensure to carry out these services as required by applicable state laws. By providing the requested information, the entity named above represents and warrants that it is authorized to disclose such information to a third party such as Amgen. The entity named also represents and warrants that the information submitted in the registration form is accurate and up to date.

Listing a treatment site in the Amgen Rare Disease Infusion Site Locator^™, is not a guarantee that any particular healthcare professional or patient will choose the treatment site. It is understood that listing a treatment site in the Amgen Rare Disease Infusion Site Locator^™, is not a guarantee of business and that Amgen is not providing referrals. In the event a treatment site is chosen through the Amgen Rare Disease Infusion Site Locator^™, it is the duty of each provider, patient, and treatment site to understand payer-specific policies. Prior authorization may be required. Amgen assumes no liability for patient payment or care.

The entity named above agrees to be listed in the Amgen Rare Disease Infusion Site Locator^™, and to receive communication related to the Amgen Rare Disease Infusion Site Locator^™, and similar Amgen services.

Both Amgen and the entity named above reserve the right to end this agreement with 30 days advance notice to ensure patient treatment is not disrupted. If there is “cause,” then agreement may be terminated immediately.

By submitting this form, I verify that I am an employee or agent of the site listed above and I am authorized to add, edit, or delete this account profile.