Simply click the print button to print this activated discount drug card. Simply bring this card into your local
pharmacy and present it to your pharmacist for discounts up to 75%.
PATIENTASSISTANCE.COM
Your 10-digit phone number
CLAIMNE
900020
DISCOUNT
Also try at your local WalMart Pharmacy or Sam's Club Pharmacy
Member Name
Give SSN to Pharmacy
011669
36390000
Pharmacist
Information: This is a discount prescription drug card and is free to our members. Please take the above processing codes and enter into
your system with our members prescription information. Thank you for helping others.