Legal Pharmacy Lien

LEGAL PHARMACY LIEN

This Pharmacy Lien Agreement (the "Agreement") is made as of by and between Pharmacy Name: whose principal place of business is (hereinafter "Pharmacy"), and Patient / Responsible Party Name: of (hereinafter "Patient").

RECITALS

WHEREAS, Pharmacy has provided pharmaceutical products, medications, and related professional services to Patient and has billed Patient for said goods and services; and

WHEREAS, Patient acknowledges an unpaid balance for the pharmacy charges described herein and recognizes Pharmacy's right to secure payment by asserting a lien against the tangible property and proceeds resulting from the prescription supply and related services provided by Pharmacy; and

WHEREAS, the parties desire to set forth their understanding concerning the creation, perfection, priority, enforcement, and cure of a lien in favor of Pharmacy to secure payment of outstanding charges.

NOW, THEREFORE, in consideration of the mutual promises set forth below, the parties agree as follows:

1. DEFINITIONS

For purposes of this Agreement, the following terms have the meanings set forth below:

"Charges" means all amounts owing to Pharmacy for medications, compounded products, dispensing fees, professional services, storage, handling, and other pharmacy-related costs described in Section 3 below, together with interest, collection costs, and reasonable attorneys' fees permitted by law.

2. GRANT OF LIEN

Patient hereby grants to Pharmacy a security interest and lien in and to all tangible pharmaceutical goods, containers, labels, and any proceeds arising from the sale or disposition of such goods that Pharmacy has supplied to or is holding for Patient, as security for payment of all Charges arising from Pharmacy's provision of goods and services through the date of payment in full.

3. AMOUNT SECURED; INVOICING

4. SCOPE AND EXCLUSIONS

The lien granted by Patient covers only those specific tangible items supplied by Pharmacy and the proceeds thereof. The lien does not attach to Patient's non-tangible rights or to property lawfully owned by third parties except to the extent that such property contains or derives from the Pharmacy-supplied goods. Pharmacy's lien does not extend to items returned to Patient upon full payment or lawful release.

5. PRIORITY, PERFECTION, AND NOTICE

Pharmacy may perfect its lien and security interest to the fullest extent permitted by applicable law, including by taking possession of goods, filing a lien statement, or providing written notice to third-party payors. Patient hereby consents to Pharmacy taking such actions to perfect and enforce the lien. Pharmacy will provide written notice to Patient prior to filing any public notice as required by law.

Patient expressly consents to Pharmacy's taking of any commercially reasonable action to perfect or enforce this lien, including filing of lien statements or retention of possession until payment in full.

6. REMEDIES ON DEFAULT

Upon Patient's failure to cure the outstanding Charges within the time specified in a written demand, Pharmacy shall have all remedies available under law and equity, including retaining possession of goods, foreclosure of the lien, sale of liened property at public or private sale after reasonable notice to Patient, and pursuit of deficiency judgments. Any sale will be conducted in a commercially reasonable manner and proceeds will be applied in the following order: (a) costs of sale and enforcement, (b) reasonable attorneys' fees, (c) accrued interest, (d) principal balance of Charges, and (e) any surplus returned to Patient.

7. REDEMPTION AND CURE

Patient may cure a default by paying the full outstanding Charges plus any reasonable costs of storage and enforcement no later than the time specified in Pharmacy's written demand notice. If Patient cures prior to sale or disposition, Pharmacy shall release the lien as required by law and return possession of any held goods to Patient.

8. ACCOUNTING; APPLICATION OF PAYMENTS

Pharmacy shall maintain and, upon Patient's written request, provide a reasonably detailed accounting of charges, payments, and disbursements applied to the account. Payments shall be applied first to costs of collection and enforcement, then to accrued interest, and thereafter to principal Charges unless otherwise required by law or agreed in writing.

9. NOTICES

All notices required or permitted under this Agreement shall be in writing and delivered in person, by certified mail (return receipt requested), or by nationally recognized overnight courier to the addresses provided below or to such other address as a party may designate in writing.

10. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the state specified in the Pharmacy's principal place of business without regard to choice-of-law rules. The parties submit to the exclusive jurisdiction of the courts of that state for any action arising from or relating to this Agreement.

11. ENTIRE AGREEMENT; SEVERABILITY

This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations and agreements, whether written or oral. If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

12. AMENDMENT; WAIVER; COUNTERPARTS

This Agreement may be amended only by a written instrument signed by both parties. No waiver of any breach shall constitute a waiver of any other breach. This Agreement may be executed in counterparts, each of which shall be deemed an original and together shall constitute one instrument.

13. ACKNOWLEDGMENT

Patient acknowledges receipt of a copy of this Agreement, confirms understanding of the lien being granted, and agrees that Pharmacy may exercise the rights enumerated herein in the event of nonpayment.

Patient Initials:     Date Signed:

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