Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with GSK Patient Assistance Program before sending sensitive documents. FaxFlow is not affiliated with this organization.
GSK Patient Assistance Program fax number
(855) 474-3063
Patient Access Programs
Used for: Vaccine dose authorization request and enrollment communications (PAP) and subsequent vaccine dose fulfillment
Fax destination details
- Department
- Patient Access Programs
- Purpose
- Vaccine dose authorization request and enrollment communications (PAP) and subsequent vaccine dose fulfillment
- Form
- Vaccine Dose Authorization Request Form (DARF) — GSK Vaccine Dose Authorization Request Form
- Address
- PO Box 220590, Charlotte, NC 28222-0590
- Voice phone
- 1-866-728-4368
- 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.
Fill Section 1 (Applicant) and Section 2 (Prescriber) and Section 3 (Dose Release) as required; sign and fax the completed form to 1-855-474-3063.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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