To help your patient apply for First Resource, call 1-877-744-5675. Once a First Resource Counselor determines a patient’s needs and eligibility, the patient will need to complete an enrollment form. A patient’s eligibility can be determined over the phone and an initial supply of medicine is either sent to the patient (oral medicine) or the office of the health care professional (IV medicine). A completed application with proof of income is required within 30 days in order to be evaluated for continued assistance.

The completed enrollment form can be faxed to 1-800-708-3430 or mailed to:

Pfizer First Resource
PO Box 220582
Charlotte, NC 28222-0582

The following patient information is required for the application:

• Name and address
  
  
• Date of birth
  
  
• Household size and monthly income*
  
  
• Insurance information
  
  
• Doctor’s name
  
  
• Social security number may be required to complete the benefits verification