Eligible patients may save up to $15 off on each of up to 6 qualifying prescriptions for PROVENTIL HFA.
PROVENTIL HFA is a prescription medication. Only your health care provider can decide if PROVENTIL HFA is right for you.
RxBIN: 610524 RxPCN: Loyalty RxGRP: 50776489 ISSUER: (80840) ID: 770443062
How this coupon works:
Prescriber
To initiate a coupon for an appropriate patient to use up to 6 times, you should:
Pharmacist
  • Coupon is valid only when accompanied by a prescription for PROVENTIL HFA. Coupon value may not exceed actual out-of-pocket cost or $15, whichever is less. Please review Terms and Conditions on coupon for important eligibility restrictions.
  • Submit transaction to McKesson Corporation using BIN No. 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. For cash-paying patients, Pharmacist agrees to charge no more than the usual and customary retail price.
  • For all other prescriptions, please use the patient's primary method of payment and a new RX number. Please clear COB secondary screen after processing transaction.
  • Acceptance of this coupon and your submission of claims are subject to the Terms and Conditions, posted at www.mckesson.com/mprstnc, and the Terms and Conditions of this coupon.
  • By processing this coupon, you agree that PROVENTIL HFA was dispensed pursuant to this coupon and that you will not submit a claim for reimbursement to Medicaid, Medicare, or any other state, federal, or other government program. You also agree not to submit any claim for reimbursement to any third-party payer who reimburses or pays any part of the prescription price or otherwise provides coverage for PROVENTIL HFA for Massachusetts residents.
  • You agree to notify the patient's insurance carrier of this coupon redemption, as may be required by the Terms and Conditions of your relationship with the insurance carrier.
  • This coupon may not be applied toward any other pharmacy purchase.
  • For pharmacy processing questions, please call the Help Desk at 877-264-2440 (8 AM-8 PM ET, Monday-Friday).
Terms and Conditions
  • This coupon is valid for up to $15 off on each of up to 6 qualifying prescriptions for PROVENTIL HFA.
  • Limit 1 coupon per patient for the duration of the program.
  • Coupon is valid for use 6 times only. Patient must have a copayment or make full cash payment for the prescription. Savings are limited to amount of your out-of-pocket cost, up to a maximum of $15 per prescription for up to 6 qualifying prescriptions.
  • No other purchase is necessary.
  • This coupon is not transferable. No substitutions are permitted. Cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer.
  • This coupon is not insurance.
  • This coupon is valid for patients with private insurance or cash-paying patients. Not valid for patients covered under Medicaid, Medicare, a Medicare Part D or Medicare Advantage plan (regardless of whether a specific prescription is covered), TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan ("Healthcare Reform"), or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program.
  • This coupon is void for Massachusetts residents if a third-party payer reimburses or pays any amount of the prescription price or otherwise provides coverage for PROVENTIL HFA.
  • You must be 18 years of age or older to redeem this coupon for yourself or minor. Patient, guardian, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the recipient through this offer. Patient or guardian is responsible for reporting receipt of coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using this coupon, as may be required.
  • This coupon can be used only by eligible United States or Commonwealth of Puerto Rico residents at participating eligible retail or mail-order pharmacies in the United States or the Commonwealth of Puerto Rico. Product must originate in the United States or the Commonwealth of Puerto Rico.
  • This coupon is the property of Merck and must be turned in on request.
  • It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit this coupon. Void if reproduced. Void where prohibited by law, taxed, or restricted.
  • Merck reserves the right to rescind, revoke, or amend this offer at any time without notice.
  • Please read the Patient Information and discuss it with your doctor.
  • Expiration Date: 06/30/2013.
Copyright © 2012 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. All rights reserved
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