Notice of Privacy Practices

West Village Pharmacy Inc · 3901 Conshohocken Avenue #2, Philadelphia, PA 19131
Effective date: October 26, 2026

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of your pharmacy record

• You can ask to see or get a paper or electronic copy of your prescription and health information that we have about you. Ask us how to do this.
• We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your record

• You can ask us to correct health information about you that you think is incorrect or incomplete.
• We may say "no" to your request, but we'll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, by cell phone instead of home phone) or to send mail to a different address.
• We will say "yes" to all reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say "no" if it would affect your care.
• If you pay for a prescription or service out-of-pocket in full, you can ask us not to share that information with your health insurer for payment or operations. We will say "yes" unless a law requires us to share it.

Get a list of those with whom we've shared information

• You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all disclosures except those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We'll provide one list a year for free but may charge a reasonable, cost-based fee if you ask for another within 12 months.

Get a copy of this notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide it promptly.

Choose someone to act for you

If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority before we take any action.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting our Privacy Officer using the information above.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care, including letting a family member or caregiver pick up your prescriptions.
• Share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes (refill reminders and information about a drug you are already taking are not marketing).
• Sale of your information.

We do not conduct fundraising.

Our uses and disclosures

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you. Example: we call your doctor to clarify a prescription, or check your other medications for interactions.

Run our pharmacy

We can use and share your health information to run our pharmacy, improve your care, and contact you when necessary. Example: we use your information to send refill reminders, manage medication synchronization and pill packaging, or review the quality of our services.

Bill for your services

We can use and share your health information to bill and get payment from health plans, pharmacy benefit managers, or other entities. Example: we give information about your prescription to your Medicare Part D or Medicaid plan so it will pay for your medication.

Business associates

We may share your information with companies that perform services for us, such as software, billing, delivery, or record-keeping vendors. They are required by contract to protect your information.

How else can we use or share your health information?

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

• Help with public health and safety issues: preventing disease; reporting immunizations to the state immunization registry; helping with product recalls; reporting adverse reactions to medications to the FDA; reporting suspected abuse, neglect, or domestic violence; and preventing or reducing a serious threat to anyone's health or safety.
• Prescription monitoring: reporting controlled substance prescriptions to the Pennsylvania Prescription Drug Monitoring Program as state law requires.
• Do research: we can use or share your information for health research under conditions set by law.
• Comply with the law: we will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.
• Respond to organ and tissue donation requests and work with a medical examiner or funeral director when an individual dies.
• Address workers' compensation, law enforcement, and other government requests: for workers' compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies (such as the Pennsylvania State Board of Pharmacy or the DEA) for activities authorized by law; and for special government functions such as military, national security, and presidential protective services.
• Respond to lawsuits and legal actions: we can share health information about you in response to a court or administrative order, or in response to a subpoena.

Information with extra protection

Pennsylvania law gives extra protection to certain information, including HIV-related information, drug and alcohol abuse treatment information, and mental health treatment information. When state or federal law is more protective of your privacy than this notice, we follow the more protective law. In many cases this means we will ask for your specific written consent before sharing that information.

Substance use disorder treatment records

If we receive records from a substance use disorder treatment program covered by federal law (42 CFR Part 2), those records, and testimony describing their contents, will not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you unless you give written consent or a court issues an order after giving you notice and an opportunity to be heard, as required by Part 2. If you have signed a consent allowing your Part 2 records to be shared for treatment, payment, and health care operations, we may use and redisclose them as permitted by HIPAA.

Other uses require your written permission

Uses and disclosures not described in this notice will be made only with your written authorization. You may revoke an authorization at any time by writing to our Privacy Officer, except to the extent we have already acted on it.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing.

For more information, see www.hhs.gov/hipaa/for-individuals/notice-privacy-practices.

Changes to the terms of this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, at the pharmacy counter, and on this website.

Acknowledgment

We will ask you to sign or initial an acknowledgment that you received this notice the first time we fill a prescription for you. If you choose not to sign, we will still fill your prescription.