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NeedyMeds

PP-PAT-USA-0585 2017 Pfizer Inc. Printed in USA/October 2017 Box 66585, St. Louis, MO 63166-6585 T: 866-706-2400 F: 866-470-1748 The Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance FoundationTM. The Pfizer Patient Assistance Foundation is a separate legal entity from Pfizer Inc. with distinct legal restrictions. Group A Do I Qualify for Free Medicine Through the Pfizer Patient Assistance Program?You should complete this enrollment form if you:PHave been prescribed a Pfizer Group A medicine, including:Pfizer Patient Assistance Program:Instructions for Group A Enrollment FormThis enrollment form is for patients who would like to apply to receive any of the Group A medicines found below for free through the Pfizer Patient Assistance Program.

Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. REMEMBER - Send your completed application to address on the form, NOT to NeedyMeds.

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