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Pfizer enCompass Enrollment Form for INFLECTRA …

Pfizer enCompass Enrollment Form for INFLECTRA

www.pfizerencompassresources.com

To be eligible for this program, you must be commercially insured and not be enrolled in a state- or federally funded insurance program. Please see full terms and conditions. Co-Pay Program Consent and Attestation: The checkboxes below must be completed if you are requesting enrollment in the Pfizer enCompass Co-Pay Assistance Program.

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