Pharmacy Notice of Privacy Practices

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.

The Pharmacy is required by law to maintain the privacy of Protected Health Information (“PHI”) and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices (“Notice”) describes how we may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. The Notice also describes your rights with respect to PHI about you.

The Pharmacy is required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. In the event of a material change in this Notice, we will post revised notices at each of our Pharmacies and on our website at www.bigy.com/services/policies.

Your Health Information Rights

You have the following rights with respect to PHI about you:

Obtain a paper copy of the Notice upon request. You may request a copy of the Notice at any time. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy. To obtain a paper copy, contact: Privacy Officer, Big Y Foods, Inc., 2145 Roosevelt Ave., Springfield, MA 01102.

Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use or disclosure of PHI about you by sending a written request to Privacy Officer, Big Y Foods, Inc., 2145 Roosevelt Ave., Springfield, MA 01102. We are not required to agree to your request, however, unless otherwise required by law, we must permit a request for a restriction on disclosures to a health plan for purposes of payment or health care operations where the PHI pertains solely to a health care item or service for which the health care provider involved has been paid out of pocket in full.

Inspect and obtain a copy of PHI. You have the right to access and copy PHI about you contained in a designated record set for as long as the Pharmacy maintains the PHI. The designated record set usually will include prescription and billing records. To inspect or copy PHI about you, you must send a written request to Privacy Officer, Big Y Foods, Inc., 2145 Roosevelt Ave., Springfield, MA 01102. Your request will be acted upon within 30 days, unless we provide you with notification in writing that an extension of up to 30 days is needed. If you wish, you may request, in writing on a form provided by the pharmacy, that your health information is directed to someone other than yourself. We may charge you a fee for the costs of copying, mailing and supplies that are necessary to fulfill your request. We may deny your request to inspect and copy in certain circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.

Request an amendment of PHI. If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a written request to Privacy Officer, Big Y Foods, Inc., 2145 Roosevelt Ave., Springfield, MA 01102. You must include a reason that supports your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may give a rebuttal to your statement.

Receive an accounting of disclosures of PHI. You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14, 2003. The accounting will exclude certain disclosures, such as disclosures for treatment, payment, or health care operations, disclosures made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations. To request an accounting, you must submit a request in writing to: Privacy Officer, Big Y Foods, Inc., 2145 Roosevelt Ave., Springfield, MA 01102. Your request must specify the time period, but may not be longer than six years. The first accounting you request within a 12 month period will be provided free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.

Request communications of PHI by alternative means or at alternative locations. For instance, you may request that we contact you about medical matters only in writing or at a different residence or post office box. To request confidential communication of PHI about you, you must submit a request in writing to: Privacy Officer, Big Y Foods, Inc., 2145 Roosevelt Ave., Springfield, MA 01102. Your request must state how or where you would like to be contacted. We will accommodate all reasonable requests.

Receive notification about a breach of PHI. We will notify you if we become aware that there has been a breach of your unsecured PHI in a manner that could compromise the privacy of your PHI.

How We May Use and Disclose PHI

Except as provided below (see “State Limitations on Uses and Disclosures”), the following are descriptions and examples of ways we may use and disclose your PHI without your authorization:

We may use or disclose your PHI for treatment purposes. Treatment includes using and disclosing your health information and sharing it with other professionals who are treating you. Example: Information obtained by our pharmacists may be used to dispense prescription medications to you. We will document in your record information related to the medications dispensed to you and services provided to you.

We may use or disclose your PHI for payment purposes. Payment includes using and disclosing your health information to bill and get payment from health plans or other entities. Example: We may contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount of your copayment. We will bill you or a third-party payor for the cost of prescription medications dispensed to you. The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you are taking.

We may use or disclose PHI for health care operations. Health care operations include uses and disclosures of PHI to run our pharmacies, improve your care, and contact you when necessary. Example: The Pharmacy may use information in your health record to monitor the performance of the pharmacists providing treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

We also may use or disclose your PHI for the following purposes without your authorization:

Business associates: There are some services provided by us through contracts with business associates. Examples include a computer vendor used to bill your claim, or Medicare billing company. When these services are contracted for, we may disclose PHI about you to our business associate so that they can perform the job we have asked them to do and bill you or your third-party payor for services rendered. To protect PHI about you, we require the business associate to appropriately safeguard the PHI.

Communication with individuals involved in your care or payment for your care: Health professionals such as pharmacists, using their professional judgment, may disclose to a family member, other relative, close personal friend you identify and who is involved in your care or payment relates to your care, PHI relevant to that person's involvement in your care or payment related to your care. If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your PHI with such person 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.

Health related communications: We may contact you to provide refill reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

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 replacement.

Worker's compensation: We may disclose PHI about you as authorized by and as necessary to comply with laws relating to worker's compensation or similar programs established by law.

Public health: As required by law, we may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Law enforcement: We may disclose PHI about you for law enforcement purposes as required by law or in response to a valid subpoena or other legal process.

As required by law: We must disclose PHI about you when required to do so by law.

Health oversight activities: We may disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws. The Pharmacy is required to disclose your PHI to the Secretary when the Secretary requires it in the course of an investigation or to determine the Pharmacy's compliance with certain HIPAA requirements. Judicial and administrative proceedings: If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested PHI.

Research: We may disclose PHI about you to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information.

Coroners, medical examiners, and funeral directors: We may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to carry out their duties.

Organ or tissue procurement organizations: Consistent with applicable law, we may disclose PHI about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Correctional institution: If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others.

To avert a serious threat to health or safety: We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Military and veterans: If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority.

National security and intelligence activities: We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective services for the President and others: We may disclose PHI about you to authorized federal official so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

Victims of abuse, neglect, or domestic violence: We may disclose PHI about you to a government authority, such as a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect, or domestic violence. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else or the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you.

Other Uses and Disclosures of PHI

The Pharmacy will obtain your written authorization before using or disclosing PHI about you 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 by following the procedure described in the authorization for you signed. 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 written authorization is generally required before the Pharmacy will use or disclose psychotherapy notes about you. Psychotherapy notes are separately field notes about your conversations with your mental health professional during a counseling session. They do not include summary information about your mental health treatment. The Pharmacy may use and disclose such notes when needed by the Pharmacy to defend against litigation field by you. To the extent the Pharmacy uses and discloses your PHI for certain marketing purposes. It will obtain your specific authorization to the extent required by law. Additionally, any disclosures that constitute the sale of your PHI will also require your specific authorization.

In addition, upon your written request on a form approved by the Pharmacy, the Pharmacy will disclose your PHI to a third-party. You must submit a request in writing to: Privacy Officer, Big Y Foods, Inc., 2145 Roosevelt Ave., Springfield, MA 01102

State Limitations on Uses and Disclosures

Connecticut: We will not disclose information about pharmaceutical services tendered to you to third parties without your consent, except to the following persons:

a. the prescribing practitioner or a pharmacist or another prescribing practitioner presently treating you when deemed medically appropriate;
b. a nurse who is acting as an agent for a prescribing practitioner that is presently treating you or a nurse providing care to you in a hospital;
c. third party payors who pay claims for pharmaceutical services rendered to you or who have a formal agreement or contract to audit any records or information in connection with such claims;
d. any governmental agency with statutory authority to review or obtain such information;
e. any individual, the state or federal government or any agency thereof or court pursuant to a subpoena; and
f. any individual, corporation, partnership or other legal entity which has a written agreement with the pharmacy to access the pharmacy's database provided the information accessed is limited to data which does not identify specific individuals.

Sale of Information: We will not sell your individually identifiable medical record information.

Massachusetts: For Medicaid recipients: We will restrict disclosure of your information to purposes directly connected with the administration of the Medicaid program.

For More Information or to Report a Problem

If you have questions or would like additional information about the Pharmacy's privacy practices, you may contact the Privacy Officer at Big Y Foods, Inc., 2145 Roosevelt Ave., Springfield, MA 01102, or call the Privacy Officer at (888) 306-0618. If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Effective Date
This Notice is effective as of September 21, 2017
4845-9734-1974, v. 3