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supplies and needs...online!

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Receive Your Diabetic Supplies
At Little Or No Cost To You...

Receive a blood glucose meter with no out-of-pocket cost to you.*   -   FREE DELIVERY NATIONWIDE

*Offer valid with your first filled order of test strips and lancets.

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 kit you would like to receive at no cost with your first order of strips and lancets.

Abbott

Precision Xtra Blood Glucose Meter by Abbott- Diabetic & Medical Supplies
Precision Xtra

FreeStyle Lite Blood Glucose Meter from Abbott- Diabetic & Medical Supplies
FreeStyle Lite

Abbott FreeStyle Freedom Blood Glucose Meter- Diabetic & Medical Supplies
FreeStyle Freedom

Bayer

Bayer Breeze 2 Blood Glucose Meter- Diabetic & Medical Supplies
Breeze 2

Bayer Contour TS Blood Glucose Meter- Diabetic & Medical Supplies
Bayer Contour TS

Bayer DEX Blood Glucose Meter- Diabetic & Medical Supplies
DEX

LifeScan

LifeScan OneTouch UltraSmart Blood Glucose Meter- Diabetic & Medical Supplies
OneTouch UltraSmart

OneTouch Ultra Mini Blood Glucose Meter- Diabetic & Medical Supplies
OneTouch Ultra Mini

LifeScan OneTouch Ultra 2 Blood Glucose Meter- Diabetic & Medical Supplies
OneTouch Ultra2

LifeScan OneTouch Ultra Blood Glucose Meter- Diabetic & Medical Supplies
OneTouch Ultra

LifeScan OneTouch Select Blood Glucose Meter- Diabetic & Medical Supplies
OneTouch Select

 

Roche

Roche Accu-Chek Advantage Blood Glucose Meter- Diabetic & Medical Supplies
Accu-Chek Advantage

Roche Accu-Chek Compact Plus- Online Diabetic Supplies
Accu-Chek Compact Plus

Roche Accu-Check Active- Online Diabetic Testing Supplies
Accu-Chek Active

Roche Accu-Check Aviva- Testing Supplies For Diabetics
Accu-Chek Aviva

 

 

Sanvita

Sanvita NovaMax Blood Glucose Meter- Diabetic & Medical Supplies
NovaMax

Sanvita NovaMax Link Blood Glucose Meter- Diabetic & Medical Supplies
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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