Online Claim Form

MUST SUBMITTED ONLINE NO LATER THAN APRIL 29, 2024

This Claim Form is for use in submitting a claim for a payment by check of up to $55 under the class action settlement agreement in the case of BPP v. The Compounding Center, Inc. d/b/a TCC Pharma, Inc., Case No. 20SL-CC04149, in the Missouri Circuit Court for the Twenty-First Judicial Circuit, St. Louis County (“Action”). Before submitting this Claim Form, please read carefully the Long Form Notice, Settlement Agreement and Release, Preliminary Approval Order, and other information available in the Important Documents section of this website.

To be eligible for payment, you MUST fully complete, sign, and date this Claim Form no later than April 29, 2024. This information is required so that your entitlement to a settlement benefit can be verified. If you do not comply with these requirements, your claim will be denied.

1. PRINT the full name, address, and telephone numbers of the Settlement Class Member submitting this Claim Form:

First Name

Last Name

Business Name (if applicable)

Address 1

Address 2

City

State

Zip Code

Contact Phone

2. PROVIDE the facsimile number at which you received a Fax Advertisement from The Compounding Center, Inc. d/b/a TCC Pharma, Inc., between August 12, 2016, and January 29, 2024:

Facsimile Number 1

Facsimile Number 2 (Optional)

Facsimile Number 3 (Optional)

3. COMPLETE THE FOLLOWING VERIFICATION:

Under penalty of perjury, I declare to the Missouri Circuit Court for Missouri Circuit Court for the Twenty-First Judicial Circuit, St. Louis County, that the following information is true and correct:

(1) I am the person identified in this Claim Form; and

(2) I received a Fax Advertisement from The Compounding Center, Inc. d/b/a TCC Pharma, Inc., between August 12, 2016, and January 29, 2024, at the Facsimile number identified above.

(3) At the time I received the Fax Advertisement, I was the account holder or owner of the Facsimile number identified above.

E-Signature

Date