2016-2017 FLU SHOT
AND TDAP VOUCHER*
COMPANY LOGO HERE
TRIVALENT, QUADRIVALENT, HIGH DOSE, TDAP
WE CARE ABOUT YOUR HEALTH!
Rite Aid and your employer are pleased to offer you this immunization voucher to help protect you.
TO GET VACCINATED AT ANY RITE AID STORE BY A CERTIFIED IMMUNIZING PHARMACIST: Visit any
of our stores anytime and present this voucher and your insurance card. To find the store nearest you
visit riteaid.com/flu or call 1-866-751-1494.
NOTE TO RITE AID IMMUNIZING PHARMACISTS:
Process claim
using Card Text:
Pharmacist: Contact Kelson Record (509-412-4575) with any questions on this voucher or billing issues. DO NOT TURN CUSTOMER AWAY! For flu shot,
enroll presenter of this voucher under the CARDTEXT “LEGACY HEALTH FLU (NOT OL)”. For Tdap shot, enroll presenter of this voucher under the
CARDTEXT “LEGACY HEALTH NONFLU (NOT OL)”. Use Last Name followed by First Name followed by DOB (MMDDYYYY) as billing ID. Processing claim
for flu shot (tri, quad, or HD) or Tdap shot through designated CARDTEXT will process with $0 copay to customer.
Employee Name:
Write your name in the box.
*Voucher for use by
LEGACY HEALTH EMPLOYEES AND THEIR ACCOMPANIED GUESTS
(3 AND OLDER IN WASHINGTON AND 7 AND OLDER IN OREGON)
only. Not transferable. Good 8/15/2016 – 3/31/17 only.
*Vaccines available while supplies last. Age restrictions apply in some states. Immunizations are only available for those 3 and older in Washington and 7 and older in Oregon. Ask at pharmacy for details.
*Vaccines available while supplies last. Age restrictions apply in some states. Ask at pharmacy for details.
One card gives
4 ways to save.
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Coupons
It’s free to sign up in store or online at RiteAid.com/Plenti
Plenti points
wellness+