Mini Pharmacy Diabetic Supplies
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Prescription Services - Mini Pharmacy Diabetic Supplies

Receive your diabetic supplies at little or no cost to you...

NO-CHARGE METER to Eligible Patients - FREE DELIVERY NATIONWIDE

  • No more running around town for the product you need.
  • No more last minute trips to the pharmacy.
  • Say goodbye to standing and waiting in line.

We accept Medi-Cal Programs, Managed Care, HMOs, PPOs, and most health plans. Mini Pharmacy will file most health plan claims for you, as well as any other paperwork that is required.

Just fill out the simple form below and we'll take care of the rest!

* Means fields are required. If you are unsure of an entry, please just write NA.

* Patient Name:

* DOB:

* Address:

* City:

* State:

* Zip:

* E-mail:

* Daytime Phone:

* Insurance Plan:

* Insurance ID#:

* Insurance Phone:

* Doctor's Name:

* Doctor's Phone:


Please select the complimentary kit you will receive with your first order of strips and lancets.

Abbott


Precision Xtra


FreeStyle Lite


FreeStyle Freedom

Bayer


Breeze 2


Bayer Contour TS


DEX

LifeScan


OneTouch UltraSmart


OneTouch Ultra Mini


OneTouch Ultra2


OneTouch Ultra


OneTouch Select

 

Roche


Accu-Check Advantage


Accu-Check Compact Plus


Accu-Check Active


Accu-Check Aviva

 

 

Sanvita


NovaMax


NovaMax Link

 


Supplies Needed:

Test Strips (100 per box) - Qty:
Lancets (100 per box) - Qty:
Syringes 1cc - Qty:
Syringes 1/2 cc - Qty:

Insulin:

Insulin NPH - # of Vials:
Insulin REG - # of Vials:
Insulin 70/30 - # of Vials:


Comments:


       


 

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