Important Safety Information
Side effects with Allegra® Oral Suspension 30 mg/5mL (6 mg/mL) are low and may include vomiting, fever, cough, ear infection and diarrhea.
Important additional information
*Some restrictions may apply. See below for details.
*Rebate offer is for up to $10 per prescription off your out-of-pocket payment when you purchase
Allegra Oral Suspension and send in rebate certificate with original pharmacy receipt. Offer not valid for prescriptions
reimbursed or paid under Medicare, Medicaid, or any similar federal or state health care program, including any state
medical or pharmaceutical assistance programs. Void in Massachusetts if any insurer or other third party payer reimburses
you or pays for any part of the prescription price. Offer void where prohibited by law, taxed, or restricted. Amount
of rebate for the purchase of Allegra Oral Suspension will not exceed amount of copay or $10 per prescription—whichever
is less. This certificate may not be reproduced and must accompany your request. Offer good only for Allegra Oral
Suspension and only in the USA. Offer expires 12/31/07. Sanofi-aventis U.S. LLC reserves the right to rescind, revoke,
or amend this offer without notice. You are responsible for reporting receipt of a rebate to any private insurer that
pays for or reimburses you for any part of the prescription filled. Limit of 12 rebates per calendar year (up to $120).
Save up to $10 per prescription on your out-of-pocket costs*
FREE important information on managing your child's seasonal allergy symptoms
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such as tips and rebate offers and developing additional products and services to serve you better. Sanofi-aventis U.S.
respects your interest in keeping your personal health information private. We will not sell or rent your information
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0-30 days (1 mo.) |
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31-60 days (2 mos.) |
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61-90 days (3 mos.) |
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91-120 days (4 mos.) |
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121-180 days (6 mos.) |
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181-240 days (8 mos.) |
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241-300 days (10 mos.) |
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301-365 days (year round) |
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Alavert® Children Syrup |
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Benadryl® |
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Claritin® Syrup |
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Clarinex® Reditabs |
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Clarinex® Syrup |
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Singulair® |
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Sudafed® |
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Zyrtec® Chewable Tablets |
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Zyrtec® Syrup |
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Sign here:
Important - you MUST sign here in order to qualify for this
rebate.
Please sign here to certify that you understand, accept, and are complying with all the requirements and
restrictions listed on this form. This also certifies that redeeming this certificate is consistent with the requirements
of your health plan.