RxBIN:
610524
RxPCN:
Loyalty
rGrP:
50775352
ISSUEr:
80840
ID: 675729593
on each Divigel® (estradiol gel) 0.1% prescription

Patient: Present this coupon to the pharmacist along with your
prescription for Divigel® to receive this benefit. *For eligible patients only and limited to a maximum savings of $25 each on 12 Divigel® prescriptions

To the 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 the Divigel® Patient Savings Program at 1-800-657-7613 (8:00 AM-8:00 PM EST, Monday-Friday). When you use this coupon, you are certifying that you understand the program rules, regulations, and terms and conditions. You are not eligible if prescriptions are paid by any state or other federally funded programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TrICArE, or where prohibited by law, and you will otherwise comply with the terms above. Vertical Pharmaceuticals, LLC reserves the right to amend or cancel this offer without notice.

To the Pharmacist: When you use this coupon, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription.

  • 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 Divigel® Patient Savings Program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc
  • Patient is 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, or where prohibited by law
  • For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for Divigel® (estradiol gel) 0.1% program at 1-800-657-7613 (8:00 AM-8:00 PM eST, Monday-Friday)