RITE AID/ECKERD
CONFIDENTIALITY AND SECURITY AGREEMENT
(Must Read)

By signing this Agreement, Associate acknowledges and agrees that Rite Aid / Eckerd Corporation has shown me a copy of HR 1.54 or has provided me an opportunity to review it.  Further, Associate acknowledges and agrees that Rite Aid / Eckerd has an active ongoing program to review records and transactions for inappropriate access and that I understand that inappropriate access or disclosure of information can result in penalties up to and including termination of employment and/or legal action. Associate agrees that the obligation contained in this Confidentiality Agreement will continue after termination of employment, whether Associate’s employment is terminated voluntarily or involuntarily.

Name: ____________________________

Date: _____________________________

Signature: _________________________

*All Fields are Required

I hereby certify the following:

1. I have received, read, understand, and will abide by Rite Aid / Eckerd Corporation’s Code of Conduct, Compliance Policies, Partial Fill Policy, and Return To Stock Policy;
2. I received appropriate training on the Rite Aid / Eckerd Compliance Process before I engaged in any claims preparation or claims submission activity; and
3. I am not an Ineligible Person, and will notify Rite Aid / Eckerd if I become an Ineligible Person. (1)

Name: ____________________________

Date: _____________________________

Signature: _________________________

*All Fields are Required

1. An Ineligible Person is any individual who: (a) is currently excluded, debarred, or otherwise ineligible to participate in the Federal health care programs or in Federal procurement or non-procurement programs; or (b) has been convicted of a criminal offense related to the provision of health care items or services, but has not yet been excluded, debarred, or otherwise declared ineligible.

55 High Street
Suite 209
Mount Holly, NJ  08060
1-800-258-7747
(fax) 1-609-261-5490