1. No category

Rebates are not valid for prescriptions reimbursed under a federally funded health care program, including Medicare or Medicaid as well as similar state medical assistance
programs. Offer void where prohibited by law, taxed, or restricted. Offer good only in USA. Void where and as prohibited by law, except for prescriptions that are NOT
reimbursed by any third-party payer. Women’s Choice reserves the right to rescind, revoke, or amend this offer without notice. Offer limited to one rebate per patient.. By my
signature below, I certify that I am not being reimbursed for this product by Medicare or Medicaid, any other federal or state program, including any state pharmaceutical
assistance program. I also understand that I am repsonsible for any reporting or other requirements with respect to receipt of this rebate.
Rebates are not valid for prescriptions reimbursed under a federally funded health care program, including Medicare or Medicaid as well as similar state medical assistance
programs. Offer void where prohibited by law, taxed, or restricted. Offer good only in USA. Void where and as prohibited by law, except for prescriptions that are NOT
reimbursed by any third-party payer. Women’s Choice reserves the right to rescind, revoke, or amend this offer without notice. Offer limited to one rebate per patient.. By my
signature below, I certify that I am not being reimbursed for this product by Medicare or Medicaid, any other federal or state program, including any state pharmaceutical
assistance program. I also understand that I am repsonsible for any reporting or other requirements with respect to receipt of this rebate.
Name: _______________________________________________________________________________
Name: _______________________________________________________________________________
Address: _____________________________________________________________________________
Address: _____________________________________________________________________________
City: ________________________________________________ State: ____________ ZIP ___________
City: ________________________________________________ State: ____________ ZIP ___________
Email:_______________________________________________________________________________
Email:_______________________________________________________________________________
Physician Name: _______________________________________________________________________
Physician Name: _______________________________________________________________________
I have complied with all the terms of this offer.
I have complied with all the terms of this offer.
________________________________________________________
Signature (must be signed in order to be valid)
________________________________________________________
Signature (must be signed in order to be valid)
For questions regarding rebate offer please email: [email protected]
PHARMACEUTICALS
Rebates are invalid after 180 days of prescription fill date or dated pharmacy receipt.
For more information about Women’s Choice Pharmaceuticals and our products, please visit us at www.wcpharma.com.
For questions regarding rebate offer please email: [email protected]
PHARMACEUTICALS
Rebates are invalid after 180 days of prescription fill date or dated pharmacy receipt.
For more information about Women’s Choice Pharmaceuticals and our products, please visit us at www.wcpharma.com.
SAVE
UP TO
$40
EACH
MONTH
WITH THESE MAIL-IN REBATES
See inside for details
on individual programs.
SAVE $40
up to
$480 annual value
NESTABS ABC
PHARMACEUTICALS
*Rebate not to exceed patient copay.
Please allow 4 weeks for delivery.
This offer may not be reproduced or duplicated.
EACH
MONTH
$40
Please note: The pharmacy receipt comes with your prescription and
differs from the cash register receipt in that it identifies the product
purchased.
Send to:
Women’s Choice Pharmaceuticals
Attn: Nestabs Rebate Program
170 S. William Dillard Drive, Blg 3-109
Gilbert, AZ 85233
SAVE $30
$360 annual value
EACH
MONTH
PHARMACEUTICALS
&
Please mail in the completed rebate form (on back), along with your dated pharmacy receipt.
Product you are submitting a
rebate request for: (check one)
NESTABS
NESTABS DHA
PHARMACEUTICALS
EACH
MONTH
WITH THESE MAIL-IN REBATES
up to
Submit: This form must be filled out completely along with your dated
pharmacy receipt(s). Circle product name and purchase price.
Receive: $40 refund check for prescription
UP TO
See inside for details
on individual programs.
Please mail in the completed rebate form (on back), along with your dated pharmacy receipt.
Product you are submitting a
rebate request for:
SAVE
*Rebate not to exceed patient copay.
Please allow 4 weeks for delivery.
This offer may not be reproduced or duplicated.
Submit: This form must be filled out completely along with your dated
pharmacy receipt(s). Circle product name and purchase price.
Please note: The pharmacy receipt comes with your prescription and
differs from the cash register receipt in that it identifies the product
purchased.
Send to:
Women’s Choice Pharmaceuticals
Attn: Nestabs Rebate Program
170 S. William Dillard Drive, Blg 3-109
Gilbert, AZ 85233
Receive: $30 refund check for prescription
PHARMACEUTICALS