Privacy Notice


As you may have learned, the Regulations that apply to the privacy of health information became effective on April 14, 2003. This Pharmacy is covered by those Regulations which, in part, require that we give you a copy of our Notice of Privacy Practices at the time of our first pharmacy service to you after that date, and that we make a good faith effort to obtain your signed acknowledgement of receiving the copy.

If the service that accompanies this letter had been provided at our Pharmacy, you would have been asked to sign a form acknowledging your receipt of a copy of the Notice. Since delivery was made outside of our Pharmacy, we are asking that you cooperate with our efforts to comply with the Regulations by signing this letter and returning it to us as soon as possible.

If you have any questions concerning this letter or the Notice, please contact our Privacy Official listed below.

Thank you for your cooperation.


Gerard Acampora
Privacy Official
Tel: (203) 239-2086 Fax: (203) 239-1933


To download a copy of this form to sign for our records please click here.