Free* CONTOUR® NEXT USB Meter

Simple to use. Simple to get.

We're committed to helping you simplify your life with diabetes. That is why we made it so simple for you to get your free* meter.

All you have to do is:
  • Fill out the information below
  • Click the SUBMIT button
  • Print your coupon and bring it to your local pharmacy with a prescription from your Doctor (or simply have your doctor call in the prescription)
  • Receive your free* meter

Tell us a little about yourself:

Title *
First Name *
Last Name *
Street Address *
City *
State *
Zip *
Date of birth of meter user *
Phone (Home) *
Email *
Confirm Email *
How do you manage your diabetes?
How often do you test your blood glucose?
How do you control your diabetes?
What meter are you currently using?
What type of healthcare coverage/reimbursement for your strips?
Where do you expect to get your supplies for this meter?
submit
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*Limitations and restrictions apply. Limit one meter per person. Void where prohibited by law.

Thank you for choosing the CONTOUR® NEXT USB

To get your free* CONTOUR® NEXT USB 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 USB on the spot
Free* CONTOUR® NEXT USB
RxBIN#:
PCN#:
GROUP#:
ID#:
Offer Expires: Not currently being returned from the service

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 USB
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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