Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Bristol-Myers Squibb Patient Assistance Foundation, Inc. before sending sensitive documents. FaxFlow is not affiliated with this organization.
Bristol-Myers Squibb Patient Assistance Foundation, Inc. fax number
(800) 736-1611
Patient Assistance Foundation (BMSPAF)
Used for: Submission of patient assistance program enrollment forms for free medications; includes income verification and program eligibility documents.
Fax destination details
- Department
- Patient Assistance Foundation (BMSPAF)
- Purpose
- Submission of patient assistance program enrollment forms for free medications; includes income verification and program eligibility documents.
- Form
- Enrollment/Application form for BMS Patient Assistance Foundation — Bristol-Myers Squibb Patient Assistance Foundation Sign-Up Form
- Address
- PO Box 220769, Charlotte, NC 28222-0769
- Voice phone
- 800-736-0003
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Complete the sign-up form in full (including household income, contact info, and consent). Do not attach prescriptions. Submit by mail to P.O. Box 220769, Charlotte, NC 28222-0769 or via fax to 1-800-736-1611. If requesting a dosage change, complete the full form. For questions call 800-736-0003.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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