Transcription of Pfizer Patient Assistance Program
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Pfizer Patient Assistance Program
PP-PAT-USA-0894 2018 Pfizer Inc. Printed in USA/November 2018 Box 8509, Somerville, NJ 08876 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 .
P.O. Box 8509, Somerville, N 08876 T: 866-706-2400 F: 866-470-1748 Pfizer Patient Assistance Program: Instructions for Group A Enrollment Form P Gather the following required documents: P Completed and signed enrollment form Note: Please do not send in the Instructions, and please retain the HIPAA form for your own records.
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