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12-14-2007, 08:16 AM #1
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PRINTABLE Coupon for Free Ascencia Contour or Breeze 2 at Wa
PRINTABLE Coupon for Free Ascencia Contour or Breeze 2 at Walgreens
http://bayermeter.capturepoint.com/inde ... er=breeze2
You don't have to fill it out. Just choose Contour or Breeze 2 and click submit.
*You may proceed with printing your coupon directly by clicking "Submit" without providing any personal information. Offer available only to customers in the fifty (50) United States and the District of Columbia. Limit one blood glucose monitor per customer. Other limitations and restrictions apply. See a pharmacist for details. Offer provided by Bayer HealthCare.
This coupon is being provided to you by Bayer for one free BREEZE?2 Meter. This coupon should be taken along with a new prescription to your local pharmacy where you will receive a meter without charge. Claim for product dispensed pursuant to this card shall be submitted to WellPoint NextRx ONLY for reimbursement and not to Medicare, Medicaid or any other third party payor. Limit one BREEZE?2 Meter per person.
To the Pharmacist:
This coupon is part of the Bayer HealthCare Free Meter NPS Program.
This coupon must be accompanied by a prescription.
Please dispense one BREEZE?2 Meter at no charge to the patient. Transmit the meter claim ONLY to WellPoint NextRx.
This coupon is valid for one BREEZE?2 Meter, for the following NDC only: 00193-1440-01
Person Code is required for adjudication.
This coupon is valid for one fill only.
Refills will not be authorized with this coupon.
Please remove the identification number from the patient profile after claim is processed.
Patient name, date of birth and prescriber D.E.A. number are required for processing.
For assistance in filing this claim, please call the Pharmacy Help Desk, 1-866-291-1621.
Claim for product dispensed pursuant to this card shall be submitted to WellPoint NextRx ONLY for reimbursement and not to Medicare, Medicaid or any third party payer. Any use of this card other than as indicated constitutes fraud. Failure to produce to Bayer, on request, invoices and other information demonstrating all conditions have been met, will void all coupons submitted and you must repay Bayer all money received for all coupons under this program. Bayer reserves the right to withhold payment if it believes terms have not been met. Incomplete submissions may not be processed. This is a no charge meter and may not be billed to Medicare, Medicaid or any third party insurance. This meter is not eligible for any Bayer Manufacturer's mail-in rebate/trade-in offer and you must produce a $0.00 receipt for patient. Card may not be reproduced. Void where prohibited by law.
?2007 Bayer HealthCare LLC Diabetes Care. All rights reserved.
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