Save even more with Rewards at the Pharmacy

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Did you know Rewards at the Pharmacy is part of ExtraCare?

By joining Rewards at the Pharmacy, you can boost your healthcare savings on prescriptions, immunizations and so much more.

We need a bit more information from your Rx label.

HIPAA and CVS Privacy Authorization

We care about your privacy. Please read the following authorization and check the box to start earning your rewards.

To authorize CVS Pharmacy to send you marketing messages and to enroll in ExtraCare rewards for Rewards at the pharmacy activities, review and provide your authorization below. CVS Pharmacy┬« will only use your health information as permitted in the CVS Pharmacy Notice of Privacy Practices [View our Privacy Policy], unless you give permission to use it for the additional purposes set forth below.
I authorize CVS Pharmacy and its affiliates to use and disclose my health information:
  • To enroll in ExtraCare rewards for Rewards at the pharmacy  activities (the "Program") and administer the Program, including calculating and tracking my earned rewards pursuant to the Program Rules
  • To send marketing communications and information about programs, goods and services, including those funded by third parties
I understand that:
  • My treatment, payment for treatment and eligibility for benefits at CVS Pharmacy does not depend on my signing this Authorization.
  • Since the Program is not subject to HIPAA, the federal law that regulates use of protected health information, information used by Program or disclosed to CVS Pharmacy pursuant to this Authorization is no longer covered by the HIPAA Privacy Rule governing its use and disclosure, but I am still protected under federal and state consumer privacy laws as well as CVS Pharmacy's Privacy Policy [View our Privacy Policy].
  • I have the right to cancel this Authorization at any time by calling (1-800-746-7287) or at CVS Rx Rewards, but that my cancellation will not apply to any action that CVS Pharmacy has already taken based on my prior Authorization.
  • I am entitled to a copy of this Authorization.
  • Unless cancelled, this Authorization will expire when I revoke this Authorization except when state laws provides a shorter time frame, in which case this authorization will expire at the latest time permitted by applicable state law.
Who has and who will use my information?
CVS Pharmacy and its affiliates (the legal entities that operate our retail stores and pharmacies) will use your information to administer the Program and for marketing purposes. CVS Pharmacy will use my information as permitted by its Privacy Policy [View our Privacy Policy].
What information will be used and disclosed?
If you give your permission through this form, you are allowing CVS Pharmacy to use and disclose any information it holds about you in connection with the healthcare services it provides, including the following information:
  • Your contact information, including your full name, address, phone number, and email address
  • Your demographic information, including gender and date of birth
  • Your health information, including your prescription history, vaccination history, prescription status (e.g., eligible for refill, ready for pickup)
  • Enrollment in any CVS Pharmacy program (e.g., automatic refills).
  • Your insurance information (e.g., your insurer's name, billing details), participation in any government-funded programs and any other payment details
  • Any other personal or health information received in connection with the provision of healthcare services through CVS Pharmacy
Print HIPAA and CVS Authorization
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