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EntyvioConnect Copay Program (administered by ConnectiveRx) fax number

(844) 595-6272

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Copay Program Help Desk

Used for: Enrollment and submission of copay assistance and reimbursement requests for EntyvioConnect; fax documents to 1-844-595-6272 (Pay to Invoice and Copay Claim forms).

Fax destination details

Department
Copay Program Help Desk
Purpose
Enrollment and submission of copay assistance and reimbursement requests for EntyvioConnect; fax documents to 1-844-595-6272 (Pay to Invoice and Copay Claim forms).
Form
Pay to Invoice Request Form — EntyvioConnect Pay to Invoice Request Form
Voice phone
1-800-352-2236

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.

Fax the completed Pay to Invoice Request Form along with required documents (CMS 1500/UB04, Explanation of Benefits, supplier invoice with Entyvio price, denial/appeal docs; include patient Copay Member ID when possible) to 1-844-595-6272.

Official form instructions are published as a downloadable file on the organization's website.

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