! You must use the "Print" button on this page to receive a valid voucher.

Duplicates of this uniquely coded voucher are invalid and not redeemable at the pharmacy. PLEASE DO NOT COPY.
Date:
SAMPLE VOUCHER
Patient Name:
30 free tablets of 2.5-mg, once daily Femara (letrozole tablets) NDC 00078024915
Prescriber Signature
Dispense as Written
DEA:  
 
Not valid without a physician's signature and an affixed, valid signed prescription for Femara. Please have your physician indicate which dosage is right for you and sign this page (above). Then, take this signed page, along with a signed, valid prescription for Femara, to a pharmacy for your free trial sample of Femara.
To The Pharmacist:
Limit 1 Trial Script voucher per patient. Redeem for product only when affixed to a valid, signed prescription for Femara. Prescriber ID # required on prescription. This voucher is valid for a one-month supply of Femara. Submit claim to McKesson Specialty Arizona, Inc. using BIN # 610500. For pharmacy processing questions, please call the Help Desk at 1-800-750-9835.
· ID #: XXXXXXXXXX
· Group: W1420601
· Prescriber DEA required to process
· Date of Birth required to process
 · Dispense at no charge to patient
· Valid for reimbursement at retail pharmacies only
· One 30 day - 2.5 mg QD Starter Sample
No purchase required. This voucher shall not be submitted to any third party payor (government or commercial) for reimbursement. Void where prohibited by law. Void if reproduced. It is illegal for any person to sell, purchase or trade, or offer to sell, purchase or trade or to counterfeit this voucher. Novartis Pharmaceuticals Corp. reserves the right to rescind, revoke, or amend this offer without notice. McKesson reserves the right to review all records and documentation relating to the filling /dispensing of product consistent with all applicable laws and regulations. Please consult complete prescribing information for Femara, available at www.femara.com.©Novartis Pharmaceuticals Corporation 2005.
 
Femara Voucher
valid through 12/31/2010