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Program Details
PFIZER, INC.
Pfizer Oncology Together
Vizimpro
(dacomitinib)
|
| CONTACT
INFO |
|
| Address: |
PO Box 220366
Charlotte, NC 28222-0366 |
| Phone: |
1-877-744-5675 |
Provider Phone: |
|
| Fax: |
1-877-736-6506 |
Website: |
Program Website |
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| ELIGIBILITY
|
|
| Eligibility
Info: |
Call program for details.
Patients with Medicare Part D may be eligible.
Program provides, co-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients. |
| Income at or below: |
Not
Published |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security requested on form: |
Yes |
| US citizenship/residency specified:
|
Yes |
|
|
APPLICATION |
|
| Attachments
Required: |
Financial
Front/back of insurance cards, if applicable
|
Physician
License #
Required: |
Both DEA and State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes |
Eligibility
determination
letter sent: |
Not Published
|
|
| MEDICATION |
|
| Receives: |
Varies
|
| Shipped To: |
Varies
|
| Quantity in
Shipment: |
Varies |
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
Not Published |
| Refill Policy: |
Not Published
|
| Other Information: |
|
|
|
Last Updated: 04/29/2024
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Enrollment form for Orals