RxBIN: 610524
RxPCN: Loyalty
RxGRP: 50775543
ISSUER: (80840)
ID: 235780076
Patient:
You must present this coupon to the pharmacist along with your prescription to participate
in this program. If you have any questions regarding your eligibility or benefits
or if you wish to discontinue your participation,
call 1-800-657-7613 (8 AM-8 PM
ET, Monday-Friday).
You may be eligible to receive up to $35 off each of six prescriptions within 12
consecutive months or until program expiration. One use per 30 days.
Pharmacist:
- Submit transaction to McKesson Corporation using BIN# 610524
- If primary coverage exists, input coupon information as secondary coverage, and
transmit using the COB segment of the NCPDP transaction. Applicable discounts will
be displayed in the transaction response
- Acceptance of this coupon and your submission of claims for the coupon program are
subject to the LoyaltyScript® program Terms and Conditions established by McKesson
Corporation. By accepting this coupon, you agree to the LoyaltyScript® program Terms
and Conditions posted at www.mckesson.com/mprs
- Patient not eligible if prescriptions are paid in part or full by any state or federally
funded programs, including but not limited to Medicare or Medicaid, Medigap, VA,
DOD, or TriCare and where prohibited by law. LoyaltyScript® is not an insurance
card.
- For questions regarding setup, claim transmission, patient eligibility, or other
issues, call the Zomig Cost-Saving Coupon program at 1-800-657-7613 (8 AM-8 PM ET,
Monday-Friday)
- Offer expires 12/31/10
Eligibility Requirements:
Offer good for qualified customers 18 years of age or older for the purchase of
ZOMIG (zolmitriptan) and may not be used for any other product. All formulations
and dosages are eligible. Offer may not be combined with any other coupon, discount,
prescription savings card, free trial, or other offer. Offer not valid for prescriptions
purchased under Medicaid, Medicare, or similar federal, state or government-funded
benefit programs (such as medical assistance programs). Offer void where prohibited
by law, taxed, or restricted. Residents of Massachusetts are not eligible to participate
in this program. Offer limited to the lesser of (i) $35 per prescription for ZOMIG,
(ii) the amount of any copay, or (iii) if you are paying the full cost of the prescription
and it is less than $35, the amount paid for the prescription. Offer is good only
for the purchase of ZOMIG manufactured for AstraZeneca Pharmaceuticals LP and lawfully
purchased from an authorized retailer or distributor in the U.S. AstraZeneca reserves
the right to change or discontinue this offer at any time without notice.
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www.zomig.com
LoyaltyScript® is a registered trademark of McKesson Corporation.
McKesson Corporation - Scottsdale AZ 85251 - Patent Pending
ZOMIG and ZOMIG-ZMT are registered trademarks of the
AstraZeneca group of companies.
©2010 AstraZeneca Pharmaceuticals LP. All rights reserved. 292591 1/10
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