Directory information — verify before you send. This fax number was compiled by automated research from public sources. It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by GSK Patient Assistance Program. Before sending anything sensitive, confirm the number and receiving department directly with GSK Patient Assistance Program, and consider sending a test cover page first. FaxFlow is an independent directory, is not affiliated with, endorsed by, or sponsored by this organization, and accepts no liability for reliance on this listing.
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GSK Patient Assistance Program fax number
(855) 474-3063
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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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