PRESCRIPTION ASSISTANCE PROGRAM

"CONFIDENTIAL PRESCRIPTION CARD"

PRINT THE FOLLOWING AND PROVIDE TO YOUR PHARMACIST (WITH YOUR PRESCRIPTION) TO GET A DISCOUNT ON YOUR PRESCRIPTION

MEMBER ID #:___________________ Enter your phone number (include area code)
RX BIN: 610709
RX GROUP: FDCPRIVATE
RXPCN: 7777

Pharmacy Help Line: (TOLL FREE) 877-321-6755

Note: NO APPLICATION REQUIRED (EVERYONE IS ELIGIBLE). This card is provided to you at no cost (program is provided by non-profit). This card was designed for people who wish to keep their information confidential. Simply provide processing information to pharmacy with your prescription in order to receive a discount. This program is accepted at the majority of pharmacies around the country. Visit www.freedrugcard.us for additional information. This program provides a discount - This is not insurance.

PARTICIPATING PHARMACIES: