SAM PLE PR OG RAM

PENDOPHARM is pleased to provide the KleanLyte™ Sample Program. The card below is intended
to cover up to 100% of the cost of your first KleanLyte™ prescription for the quantity indicated on the
the card.
You should have been given specific instructions about when to take KleanLyte™ by your doctor
or nurse. Please review these instructions ahead of time. Your treatment with KleanLyte™ must be
completed before your clinical procedure.
Contact your doctor or pharmacist if you have any questions about the drug.

Click on this link to view a step-by-step video on how you can prep for your
colonoscopy with KleanLyteTM : www.youtube.com/watch?v=Kx8PEHteS3s

KleanLyteTM
Quantity: One kit (each kit contains 2 x 177 mL bottles and 1 mixing container)
Expiry: November 30, 2023
Coordination: Primary
SINGLE-USE SAMPLE

Important: This card covers up to 100% of the cost* towards a single KleanLyteTM
kit processed as a prescription in the quantity outlined above.

If the patient does not present with a prescription: Use your PHARMACIST
License Number in the PRESCRIBER ID field and PHARMACIST NAME in the PRESCRIBER
NAME field OR use “99999” in the PRESCRIBER ID field and “KLEANLYTE CARD” in the
PRESCRIBER NAME field.

Valid in Nova Scotia only.

STI Customer Support: 1-877-790-1991

*Includes drug acquisition cost, markup, dispensing fees, etc. 2205-906

Carrier: Group: Client ID: Client ID:

32 660 KLEANRCSQF596SS

Always direct the patient to read the label. For important information relating to contraindications, cautions and warnings, adverse reactions and
dosing instructions, refer to the Package Insert, which is available upon request by contacting Pendopharm, Division of Pharmascience Inc.,
Medical Information: 1-888-550-6060 or medinfo@pendopharm.com.

KleanLyteTM is a registered tradermark of Pendopharm, division of Pharmascience Inc.

© 2022 STI Technologies Limited. All rights reserved.

This program is administered with the support of STI Technologies Limited. View STI’s Privacy Policy here www.smartsti.com/privacy