You must fill out the form and check all 3 boxes (to receive emails)…two pages to complete and then you will get a printable form to mail in.* Fill your prescription at a pharmacy, circle out of pocket expenses on receipt, and then mail in with form.* One rebate per customer.

Fill out form here to get printable rebate

Printable Coupons are generally available for 5 days or less.

This Coupon has been added to the Budget101 Complete Coupon Database!