Get Started

Choose from four simple ways to enroll patients:

Fax the Enrollment Form

Select a form to print and complete:

Fax the printed form to:
1-844-208-7676 (toll free)

Once the printed enrollment form has been received, a dedicated Access Coordinator will contact you.

Enroll Patients Online

Healthcare Professionals and Patient Representatives can expedite patient enrollment and benefits verification with our secure online resource to conveniently:

  • Enroll patients electronically 24/7
  • Eliminate paperwork with electronic signatures and document upload
  • Instantly track enrolled patients’ coverage status and history
  • Access click-to-chat with an Access Coordinator
  • Submit electronic prior authorizations on select ViiV medications
Learn more about enrolling patients online

Mail the Enrollment Form

Select a form to print and complete:

Mail the printed form to:
ViiVConnect Enrollment
PO Box 220100
Charlotte, NC 28222-0100

Once the printed enrollment form has been received, a dedicated Access Coordinator will contact you.

Call Our Live Access Coordinator Team

Dedicated Access Coordinators are available to assist you with:

Call 1-844-588-3288 (toll free)
Monday – Friday, 8AM – 8PM (ET)
Multilingual options available.

Meet the Access Coordinator team

*Subject to eligibility, program terms and conditions. ViiVConnect programs do not constitute health insurance.

Pharmacists

Learn more about ViiVConnect. Call 1-844-588-3288 (toll free) to speak to a dedicated Access Coordinator who can explain VIiVConnect program features and benefits.