WHS Prescription Benefit Management

2935 S. Fish Hatchery Rd #111

Madison, WI 53711

www.whspbm.com

Free Kmart Pharmacy Rx Discount Card

Covers Brand and Generic Medication. This is a free benefit for uninsured families!

Please print off this page and cut out your new Rx discount card. You can use it immediately!

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| Kmart Pharmacy Discount Card |

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|Name: ________________________ |

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|Soc. Sec. or 9 digit random #:____________________ |

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|PDX Code: WSC Plan Code: 04 |

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|Coverage: Cardholder and Family |

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|Exp Date: NA Co-Pay: 100% |

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