We are required by law to maintain the privacy of your protected health information (“PHI”), to follow the terms of the Notice currently in effect, to give you this Notice setting forth our legal duties and privacy practices concerning your PHI and to notify affected individuals following a breach of unsecured PHI. This Notice describes how we may use and disclose your PHI. Additionally, this Notice explains the rights you have with respect to your PHI, and certain obligations we must abide by in accordance with the law. We reserve the right to amend this Notice. If we make any material revisions to this Notice, we will post a copy of the revised Notice in the pharmacy, on our website and will offer you a copy of the revised Notice. We will use and disclose your PHI for treatment, payment and health care operations. We may also use your PHI for other purposes that are permitted and/or required by law and pursuant to your written authorization. The following lists examples of how we may use and/or disclose your PHI. Any other uses not described in this Notice will only be made with your explicit written authorization, which you may revoke at any time by providing us with written notice of your revocation. Treatment We may use and disclose your PHI in order to provide you with prescription and supply services. We may use and disclose PHI about you to provide, coordinate or manage your health care services. We may disclose your PHI to other pharmacists, pharmacy technicians and health care providers that are involved in your care. You will receive an individual notice and have the opportunity to opt out of any subsidized treatment communications. For Example: Information that you or your physician provides to the pharmacist will be used to properly fill your prescription. We will document in your record information related to both medications dispensed to you and services provided. Payment We will use and disclose your PHI in order to obtain payment for the health care services we provide to you. We may also need to disclose your PHI to receive prior approval from your health plan or to determine if your health plan will cover a certain prescription or service. For Example: We contact your insurer or pharmacy benefit manager to determine payment for your prescription and the amount of your co-payment. We bill you or a third-party payer for the cost of the prescription medications dispensed to you. The information on the accompanying bill may include information that identifies you, as well as the medications you are taking. Health Care Operations We may use and disclose your PHI in connection with the management of our pharmacy. This may include: quality assessment and improvement, internal compliance audits, and performance evaluations. Additionally, we may use your PHI for our business management and general administrative activities. For Example: The pharmacy may use information in your health care record to monitor the performance of the pharmacists providing treatment to you. This information may be used for a number of reasons, including our effort to continually improve the quality and effectiveness of the health care and services we provide. Prescription Refill Reminders, Treatment Alternatives or Health-Related Benefits We may use and disclose your PHI to contact you to remind you about prescription refills, to tell you about treatment options or alternatives, or to inform you about health-related benefits or services that may be of interest to you Family Members, Relatives or Close Friends Unless you object to such disclosure, we may disclose your PHI to your family members, relatives or close personal friends, or any other persons identified by you as being involved in the treatment or payment for your medical care. If you are not present to agree or object to our disclosure of your PHI to a family member, relative or friend, we may exercise our professional judgment to determine whether the disclosure is in your best interest. If we decide to disclose your PHI, we will only disclose the PHI that is relevant to your treatment or payment, Business Associates There are some services provided by us through contracts with business associates. When these services are contracted for, we may disclose PHI about you so they can perform the job we have asked them to do and bill you or your third-party payer for services rendered. In order to protect your PHI, we require the business associate to appropriately safeguard the information. Food and Drug Administration (FDA) We may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacements. Other Permitted and Required Uses and Disclosures We may use your PHI without obtaining your authorization and without offering you the opportunity to agree or object as follows:

• As required by law, provided however, that the use or disclosure will be made in compliance with applicable law;
• To a public health authority that is authorized by law to collect or receive such information, or to a foreign government agency that is acting in collaboration with a public health authority and these health activities generally include preventing or controlling disease, reporting deaths, reporting adverse effects of medications or problems with products, notification of communicable disease, and reporting abuse or neglect under certain circumstances;
• To a health oversight agency for oversight activities authorized by law, including audits and inspections, and civil, administrative or criminal investigations, proceedings or actions;
• For judicial or administrative proceedings purposes in response to a subpoena, court order, discovery request, etc. but only if efforts have been made to inform you about the request or to obtain an order protecting the information requested;
• To law enforcement to report certain injuries, comply with court orders or warrants or similar process, to identify a suspect, fugitive, missing person or victim or to report a crime;
• To a coroner or medical examiner to perform duties authorized by law such as identification of a deceased person or determining the cause of death;
• To funeral directors, consistent with applicable law, as necessary to carry out their duties; to organ procurement organizations or similar entities for the purpose of facilitating organ, eye or tissue donation and transplantation;
• For research purposes provided that certain approvals take place and assurances are given. We may disclose PHI about you to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information has approved their research. Governors Pharmacy is not allowed to receive any money or other thing of value in connection with the use or disclosure of your medical information for research purposes unless the money we receive reflects the costs to prepare and transmit the medical information to the researcher or unless we seek your written authorization in advance.;
• Emergencies. We may share with a public or private agency (for example, the American Red Cross) PHI about you for disaster relief purposes. Even if you object, we still may share the PHI about you if necessary under the emergency circumstances.
• To avert a serious threat to health or safety, so long as the disclosure is only to a person who is reasonably able to prevent or lessen such threat;
• For military and veterans activities (including foreign military personnel) to assure the proper execution of a military mission and to determine eligibility for benefits;
• For national security and intelligence activities for the purpose of conducting lawful intelligence, counter-intelligence and other national security activities;
• For protection of the President and other authorized persons or foreign heads of state or to conduct authorized investigations;
• To a correctional institution or law enforcement custodian if you are an inmate or under custody; and to the extent necessary to comply with laws relating to workers’ compensation and work-related injuries.

NORTH CAROLINA STATE LAW If you receive services in North Carolina, some North Carolina State laws provide you more protection than HIPAA, and where applicable, we will follow the requirements of those State laws. The following North Carolina laws may apply to you:

1. Under North Carolina law, minors, with or without the consent of a parent or guardian, have the ability to consent to services for the prevention, diagnosis and treatment of certain illnesses including: venereal disease and other diseases that must be reported to the State; pregnancy; abuse of controlled substances or alcohol; and emotional disturbance. Abortion services, however, still require the consent of the parent, guardian or a grandparent with whom the minor has been living for at least six (6) months unless a court has determined that the minor should be treated as an adult. Minors may petition a court to waive this requirement for parental consent.
2. If you request treatment and rehabilitation for drug dependence, your request will be treated as confidential. We will not disclose your name to any police officer or other law-enforcement officer unless you consent to our sharing of it. Even if we refer you to another person for treatment and rehabilitation, we will continue to keep your name confidential.
3. If you suffer from a communicable disease (for example, tuberculosis, syphilis or HIV/AIDS), information about your disease will be treated as confidential. Other than circumstances described to you in other sections of this notice, we will not release any information about your disease except as required to protect public health, prevent the spread of a disease, or at the request of the State or Local Health Director.
4. Prescription orders on file at our pharmacies are confidential. We will disclose such orders only to the following people:

• You, if you are an adult or a minor who can consent to the treatment described in the prescription;
• Your guardian;
• Your parent if you are a minor and cannot consent to the treatment described in the prescription;
• Your doctor;
• Your pharmacist;
• A person to whom you give written authorization
• A person authorized by subpoena or a court’s order;
• Insurance companies or others who pay for your prescription;
• Members and employees of the Board of Pharmacy;
• People handling your estate;
• and Medical researchers.

5. If your pharmacy should close, for 30 days before its closing you have the right to have your files transferred to the pharmacy of your choice. ALL OTHER USES AND DISCLOSURES OF PHI Governors Pharmacy will obtain your written authorization before using or disclosing PHI for purposes other than those provided for above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing PHI about you, except to the extent that we have already taken action in reliance on the authorization. YOUR RIGHTS AS OUR PATIENT As our patient, you have a number of rights associated with your PHI. The following describes your specific rights. 1. You have the right to request restrictions or limitations on how we use and/or disclose your PHI, however, we do not have to agree to your requested restriction or limitation (except for transactions you paid for in full out-of-pocket). Your written request must specify: (1) if you would like to restrict or limit our use and/or disclosure; (2) what information you want restricted or limited; and (3) to whom the restriction or limitation applies (e.g., spouse). If we agree to your request, it will not prevent us from disclosing your PHI as follows: (1) to you if you request access or an accounting of disclosures; (2) for purposes required or permitted by law; or (3) in case of an emergency. 2. You have the right to receive confidential communications concerning your PHI by alternative means or via alternative locations. For example, you may want to receive communications related to your prescriptions at a different address other than your home address. If you wish to receive confidential communications via alternative means or locations, please submit your request in writing to the Privacy Officer and set forth the alternative means by which you wish to receive communications or the alternative location at which you wish to receive such communications. We will accommodate all reasonable requests. 3. You have the right to access, inspect and obtain a copy of your PHI, including any electronic PHI; provided, however, you are not entitled to access certain PHI exempted under HIPAA. To the extent we maintain electronic PHI, upon request we will provide you with a copy of your PHI in the format requested. If we do not have your PHI in our possession, we will provide you with the appropriate contact information when your request is received. If you request a copy of your PHI, you will receive a response to your request in a timely fashion but may be charged a reasonable, cost-based fee to cover copy costs and postage. In some limited circumstances, we may deny your request for access to PHI in which case you may request for the denial to be reviewed. If access is ultimately denied, you are entitled to a written explanation with the reason(s) for the denial. 4. You have the right to receive an accounting of disclosures of your PHI made by us, including disclosures to or by our business associate(s), for a period of six (6) years prior to the date on which you request an accounting of disclosures, or such lesser period as you indicate. You will receive one request annually free of charge and, thereafter, we may charge you a reasonable, cost-based fee for each subsequent request for an accounting of disclosures within the same twelve-month period. We will notify you of the cost for an accounting of disclosures and you may choose to withdraw or modify your request before we charge you. 5. If you believe we have PHI about you that is incorrect or incomplete, you may make a written request to us stating the reasons to support any requested amendment. You have the right to request an amendment to your PHI for so long as we maintain your PHI. If we do not have your PHI in our possession, we will provide you with the appropriate contact information when we receive your request. We will respond to your request for an amendment after we receive your request. However, we may deny your request for amendment if, for example, we determine that the PHI you requested was not created by us or is already accurate and complete. You may respond to our denial by filing a written statement of disagreement, but we have the right to rebut your disagreement. If this occurs, you have the right to request that your original request, our denial, your statement of disagreement, and our rebuttal be included in future disclosures of your PHI. 6. You have the right at any time to obtain a paper copy of this Notice, even if you receive this Notice electronically. If you have received an electronic copy of this Notice, but wish to obtain a paper copy of this Notice, please send your request in writing to the Privacy Officer at the address listed below. 7. You have the right to opt-out of fundraising and your PHI will not be used for fundraising purposes or sold without your prior authorization. ADDITIONAL INFORMATION AND QUESTIONS If you need any additional information about this notice or wish to exercise any of your rights set forth in this notice, please contact the Privacy Officer at the following address: GOVERNORS PHARMACY 50241 GOVERNORS DR CHAPEL HILL, NC 27517 Phone: 919-918-2092 Fax: 919-918-4992