Authorizing Wegmans Pharmacy to Share My Contact Information with My Wegmans Shoppers Club Account. I hereby authorize Wegmans Pharmacy to disclose to the Wegmans Shoppers Club program my name, address, telephone number(s), and email address(es), as well as any updates that I may make to that information in my Wegmans Pharmacy account during the period in which this Authorization is in effect. I am not authorizing the use or disclosure of, and Wegmans Pharmacy will not share any past, present or future prescription data or insurance information with Wegmans Shoppers Club in connection with this Authorization.

Voluntary Disclosure. I understand that authorizing this disclosure of my contact information is voluntary. I can refuse to agree to this Authorization and understand that, if I refuse, Wegmans Pharmacy cannot deny or refuse to provide treatment, payment, enrollment in a health plan, or eligibility for benefits. By authorizing the disclosure of my contact information to Wegmans Shoppers Club, I understand I will be disclosing to Wegmans Shoppers Club that I am a Wegmans Pharmacy customer.

Wegmans Privacy Policy. I understand that my contact information disclosed to Wegmans Shoppers Club will be subject to Wegmans Privacy Policy.

Expiration. This Authorization will expire on the date that I am no longer a Wegmans Pharmacy customer.

Revocation. I also have the right to revoke this Authorization at any time. If I revoke this Authorization I must do so by terminating this Authorization electronically or by presenting my written revocation to Wegmans Pharmacy. I understand any revocation will not apply to information that has already been released in reliance on this Authorization before Wegmans Pharmacy receives my notice of revocation. To revoke this Authorization at any time, I can:

Go to the Authorizations section in my Pharmacy Portal account to revoke this Authorization; or

Call Wegmans Pharmacy Support Center at: 1-855-279-7663, and request the revocation of this Authorization.

I can obtain a copy of this Authorization on my “Account” page in my Wegmans Pharmacy App.