FREE Accu-Chek Nano SmartView system.

*
Present this voucher to your pharmacist along with prescriptions for the Accu-Chek
meter, test strips and lancets.

BIN: 610524
PCN: 1016
Issuer: (80840)
Group #: 40026508
Identification #: 786801523

*Free Meter Offer: Receive a free Accu-Chek Nano or Accu-Chek Aviva meter with this voucher and a valid prescription for an Accu-Chek Nano
or Accu-Chek Aviva meter. It is not appropriate to seek payment from Medicare, Medicare Advantage, Medicaid, Medigap, VA, DOD, TRICARE or
any other government healthcare program or private payers for free products. Limit one meter per person. Valid at participating pharmacies
only. By using this voucher, you certify that you understand and agree to comply with all program rules, regulations, and terms and conditions.
Roche has the right to rescind or amend this offer without notice. Offer expires June 30, 2016.

Pharmacists: Input voucher information for the free Accu-Chek Nano or Accu-Chek Aviva meter as primary coverage. By using this voucher, you
certify that you have not submitted and will not submit a claim for reimbursement under any federal, state or other federally funded program,
including but not limited to Medicare, Medicare Advantage, Medicaid, Medigap, VA, DOD or TRICARE. Pharmacist Helpline: 1-800-657-7613
(MondayFriday, 8:00 a.m.8:00 p.m. ET).