FREE CONTOUR® NEXT METER

Bayer Diabetes - Wireless Activity Tracker Contest Prize

Week
12

Bayer Diabetes - Hockey gear

A smart, connected smoke & CO alarm that keeps you updated whether you’re home or away.

Thank you for choosing the CONTOUR® NEXT

To get your free* CONTOUR® NEXT today, just:

  • Take this coupon to your local pharmacy with a prescription from your doctor (or have your doctor call in the prescription)
  • Get your free* CONTOUR® NEXT on the spot
Free* CONTOUR® NEXT
RxBIN#:
PCN#:
GROUP#:
ID#:
015251
PRX2000
NXT9
NXT97669707
Offer Expires: 2016-06-30 23:59:59

To the Pharmacist
This coupon is part of the Ascensia HealthCare Point-of-Sale Program.

This coupon must be accompanied by a valid prescription and is good for one free* CONTOUR® NEXT
This coupon is valid for patients that have third-party coverage or cash customers.
For pharmacy processing questions, please call the Pharmacy Help Desk at 1-800-510-4836.
No substitutions permitted. Program may be cancelled at any time without notice.

Submission for Cash customers:
Submit claim as primary.
Please charge the patient the balance due.

Submission for third-party coverage:
Submit claim to patient's primary insurance first. Then submit this coupon as a secondary claim for the co-pay balance using COB fields with other coverage code 8 online to RxSolutions.
Please charge the patient the balance due.

If you cannot submit this claim electronically
Pharmacy can deduct up to $10 from patient co-pay.
Pharmacy can mail in this completed form with pharmacy prescription receipt.

- OR -
Please have the patient complete and mail this rebate form.
Patient must have the patient complete and mail this rebate form.
Patient must include with the form a copy of the pharmacy receipt, indicating meter name and amount paid, and must be postmarked by the expiration date.
Any personal information provided in association with this coupon will remain confidential and will not be shared with any third party.

Address for Redemption
(To receive rebate, all items must be included and coupon completed.)

CONTOUR® NEXT Coupon Offer. PO Box 42638 Cincinnati, OH 45242-0638

Patient/Pharmacy Name:
Address:
City:
State:
ZIP:
Check here if payment is to pharmacy.
NPI#:

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