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The information you supply will be provided to Eagle Pharmacy, a company administering AstraZeneca Direct on behalf of AstraZeneca Pharmaceuticals LP or its affiliates, for the purpose of fulfilling your prescription. Personal health information will not be rented or sold and will be secured. Eagle Pharmacy may use this information to contact your healthcare provider or insurance provider for information relevant to this request.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.FDA.gov/medwatch or call (800) FDA-1088.(800) FDA-1088.

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