Dear Patient,

I have written you a prescription for a Triax brand product. This rebate will help offset your cost when purchasing MINOCIN®. In some cases, your prescription may be free! Please make sure the pharmacist fills the prescription exactly as written in order to receive your rebate. Remember to save this coupon to receive the rebate on your next 3 refills.

Thank you.

To Patient: Take your prescription and this offer to your pharmacy. Keep this offer to use toward your next 3 refills. If your pharmacist is unable to process, mail this offer and your pharmacy receipt (with name and address circled) to:

Triax Rebate Program, 6501 Weston Parkway, Suite 370, Cary, NC 27513

You will receive your rebate check in 10 to 14 business days.

To Pharmacist:

For Insured Patients: Process a Coordination of Benefits claim using the patient's prescription insurance for the PRIMARY claim. Submit the SECONDARY claim to PDMI on the Pharmacy BenefitDirect (PBD) network using the BIN: 610020.

For Non-Insured Patients: Submit claim to PDMI on the Pharmacy BenefitDirect (PBD) network using the BIN: 610020.

Return this offer to the patient for future use. For processing questions, please call 1-866-378-3165.

MINOCIN $55 Offer
BIN#: 610020
Group#: 99990762
Member#: 39908698202

Offer limited to four (4) rebates per product per household. Offer good only in the USA and void where prohibited or otherwise restricted by law or subject to state sales tax. Vouchers are not valid for prescriptions which may be reimbursed under a federal or state healthcare program, including Medicare, Medicaid, or any other similar federal or state healthcare program, including any state medical pharmaceutical assistance program. Voucher void in Massachusetts, except for cash-paying customers (ie, those who do not have prescription coverage). This offer may be rescinded, revoked, or amended without notice. Offer expires 01/31/2009.