Prescriber: Please check the appropriate drug and provide the patient with a
new prescription. * Offer applies only to the list below:
_ AMLODIPINE _ CITALOPRAM _ SERTRALINE
_ ATENOLOL _ LISINOPRIL _ SIMVASTATIN
_ BENAZAPRIL _ LISINOPRIL/HCTZ _ ZOLPIDEM
_ BENAZAPRIL/HCTZ _ OMEPRAZOLE
This voucher may be redeemed for a 30 days supply of the medication checked, with a written
prescription from your doctor. This offer applies only to a NEW prescription of medication
you have not been previously taking. This offer does not apply to medication refills,
medication transferred from another pharmacy, and may not be used with any other offers.
Vouchers may not be used against any co-pay or in conjunction with any Medicare or
Medicaid plan. This voucher is good only at the Aries Pharmacy at 8200 State Route
366, in Russells Point, Ohio, (937) 843-3700.
Patient: By presenting this voucher, I am certifying that I have
never been on this medication before, and I am requesting that
my insurance not be billed for any part of this prescription.
Print this page and bring to the pharmacy along with a new prescription for one of the above generic medication.