Prevnar 13 ® Temporary Return Goods Program

This form MUST be Included with the Return Shipment

69ab5755-9317-4f6e-b482-784e9951bb20
Retail Form

December 15, 2021 - February 28, 2022

February 28, 2022

  1. All customers must include a copy of your Prevnar 20 invoice.
  2. This is a one-time return allowance for in-date product only. For any returns after February 28, 2022, Pfizer will accept the return of both in-dated and expired product, and it will be reimbursed in accordance with Pfizer’s standard returns policy at WAC-10%.
  3. The quantity of returned Prevnar 13 doses must not exceed the quantity of purchased Prevnar 20 doses.
Please enter a RA Issue Date
In order to process your return request you will need to create a unique identifier. This is a series of numbers and/or letters after the PCV20R prefix. Please do not use spaces, special characters, or dates.
PCV20R
Please enter a Debit Memo Please do not use spaces, special characters, or dates.
Please enter an Account Name
Please enter an Account Full Address
If no DEA, please provide HIN Please enter a DEA
if applicable
if applicable
Please enter an Account Contact Name
Please enter an Account Contact Phone #
Please enter an Account Email Address

Products Returning

List details for all items being returned.

NDC *
Lot/Batch *
Expiry Date *
Dose Qty *
Attachment(s)
Please click the box below to add your Prevnar 20 proof of purchase (invoice):
Please attach your Prevnar 20 proof of purchase (invoice).

Drag and drop your file here or click to add.

By submitting this form, I attest that no returned doses were provided by the VFC or other government agencies.

If you have any questions, please contact Pfizer Customer Service at 1-800-666-7248.

NOTICE OF OBLIGATION TO REPORT DISCOUNTS: Payment of the returns refund and the shipping credit are discounts on the purchase of Prevnar 20 that must be properly and accurately accounted for and reported by Program customers in accordance with all federal and state laws, including the Anti-Kickback Statute and its implementing regulations (e.g., 42 U.S.C. § 1320a-7b, 42 C.F.R. Part 1001 et seq.) and the safe harbor for discounts (42 C.F.R. § 1001.952(h)).

Prevnar 13 1x10 pkg
Prevnar 13 1x1