Effective Date: August 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.


This Notice of Privacy Practices describes how Potter's House Apothecary, LLC and its affiliated entities (collectively, "Potter's House," "we," "us," or "our") may use and disclose your protected health information ("PHI") to carry out treatment, payment, and health care operations, and for other purposes permitted or required by law. It also describes your rights regarding your PHI. Potter's House is a compounding pharmacy located in the State of Arizona and licensed in various states in the United States and is committed to maintaining the privacy of your PHI in accordance with the Health Insurance Portability and Accountability Act ("HIPAA"), its implementing regulations, and applicable state laws. We are required by law to maintain the privacy of your PHI, to provide you with this Notice of our legal duties and privacy practices, and to abide by the terms of the Notice currently in effect.

1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

Your PHI may be used and disclosed for treatment, payment, and health care operations, and for other purposes permitted or required by law. We may share your PHI with third parties that perform services on our behalf ("Business Associates"), each of which is required by contract to protect your PHI. The following categories describe the ways we may use and disclose your PHI. Not every use or disclosure will be listed, but every permitted use or disclosure will fall within one of these categories.

Treatment. We use and disclose your PHI to fill and refill your prescriptions, to compound medications prepared specifically for you, to provide pharmacist counseling, and to coordinate your care. For example, we may contact your prescribing practitioner to clarify a prescription, recommend an alternative formulation, or report an adverse reaction, and we may send refill reminders or notify you when a compounded preparation is ready.

Payment. We use and disclose your PHI to obtain payment for the medications and services we provide. For example, we may share PHI with your health plan, pharmacy benefit manager, or a third party responsible for payment to obtain reimbursement or prior authorization, and we may provide receipts or account statements.

Health Care Operations. We use and disclose your PHI to support our pharmacy
operations. These activities include quality assessment and improvement, compliance with United States Pharmacopeia (USP) standards and accreditation requirements, staff training and competency evaluation, licensing, business planning, and general administration.

Individuals Involved in Your Care. Unless you object, we may disclose PHI to a family member, friend, or other person you identify as involved in your care or payment for your care, to the extent relevant to that involvement.

As Required or Permitted by Law Without Your Authorization. We may use or disclose your PHI without your authorization for purposes such as: public health and safety activities (including reporting adverse drug events and product recalls to the FDA); health oversight activities; law enforcement and legal proceedings, including responses to a subpoena or court order; to avert a serious threat to health or safety; for workers' compensation; and other uses required by law.

Uses and Disclosures Requiring Your Authorization. Most uses and disclosures of PHI for marketing purposes and any sale of your PHI require your written authorization. Any other uses or disclosures not described in this Notice will be made only with your written authorization. You may revoke an authorization at any time, in writing, except to the extent we have already acted in reliance on it.

2. YOUR RIGHTS

You have the following rights regarding the PHI we maintain about you:

Right to Inspect and Copy. You have the right to inspect and obtain a copy of PHI that may be used to make decisions about your care, including pharmacy and billing records, in the form and format you request if readily producible.

Right to Amend. If you believe the PHI we have about you is incorrect or incomplete, you may request that we amend it for as long as the information is maintained by or for Potter's House.

Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we have made of your PHI for purposes other than treatment, payment, or health care operations.

Right to Request Restrictions. You have the right to request a restriction on the PHI we use or disclose for treatment, payment, or health care operations, or to individuals involved in your care. We are not required to agree to a requested restriction, except that we must agree to restrict disclosure of PHI to a health plan for payment or operations purposes if you have paid for the item or service in full out of pocket.

Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location, and we will accommodate reasonable requests.

Right to a Paper Copy of This Notice. You are entitled to a paper copy of this Notice upon request, even if you have agreed to receive it electronically.

Right to Be Notified of a Breach. You have the right to be notified if we (or one of our Business Associates) discover a breach of your unsecured PHI.

To exercise any of these rights, contact our Privacy Officer using the information in Section 4.

3. OUR RESPONSIBILITIES, STATE PRIVACY RIGHTS, CHANGES TO THIS NOTICE, AND COMPLAINTS

OUR RESPONSIBILITIES

We are required by law to maintain the privacy and security of your PHI, to provide you with this Notice of our legal duties and privacy practices, to notify you following a breach of unsecured PHI, and to abide by the terms of the Notice currently in effect. We will not use or disclose your PHI other than as described in this Notice unless
you authorize us to do so in writing.

ADDITIONAL STATE PRIVACY RIGHTS

Applicable state law may provide you with additional protections regarding your medical and pharmacy records. Where state law is more protective than HIPAA, we will follow the more protective standard.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as any PHI we receive in the future. The current Notice will always show its effective date. If we make a material change, we will post the revised Notice prominently on our website at pottershouserx.com by the effective date of the change and make it available at the pharmacy and upon request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with
us by contacting our Privacy Officer using the information in Section 4. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights, at 200 Independence Avenue SW, Washington, D.C. 20201, by calling 1-877-696-6775, or online at www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

Contact Information

To exercise any of the rights described in this Notice, to request additional information about our privacy practices, or to file a complaint, please contact:

Potter's House Apothecary, Privacy Officer

21585 N. 77th Ave. #1500 Peoria, AZ 85382

Phone: 623-362-9322

Fax: 623-362-9001

Email: legal@pottershouserx.com.

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