fraud waste and abuse compliance program reporting form





notice: you are not required to reveal your identity. in addition to consulting with the compliance
officer or your supervisor, you may report any compliance concern you have by:



- Calling the anonymous Compliance Hotline at 845-791-1515


- Mailing or Faxing a Compliance Report to the Compliance Officer at:

Rock Hill Pharmacy
ATTN: Compliance Officer

P.O. Box 777

Rock Hill, NY 12775


- Completing a Compliance Reporting Form and depositing it in the Compliance Report Box


- Completing this anonymous Compliance Reporting Form: