UNPUBLISHED

UNITED STATES COURT OF APPEALS

FOR THE FOURTH CIRCUIT

No. 21-1549

SENDERRA RX PARTNERS, LLC,

 Plaintiff – Appellant,

v.

BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA,

 Defendant – Appellee.

Appeal from the United States District Court for the Middle District of North Carolina, at

Greensboro. Catherine C. Eagles, District Judge. (1:18-cv-00871-CCE-JEP)

Argued: May 4, 2022 Decided: June 1, 2022

Before KING, AGEE, and HEYTENS, Circuit Judges.

Affirmed by unpublished opinion. Judge Agee wrote the opinion, in which Judge King 

and Judge Heytens joined.

ARGUED: Adam Pierson, DLA PIPER LLP (US), Dallas, Texas, for Appellant. Adam 

Howard Charnes, KILPATRICK TOWNSEND & STOCKTON LLP, Winston-Salem, 

North Carolina, for Appellee. ON BRIEF: Marc Katz, Micala Bernardo, Breegan 

O’Connor, DLA PIPER LLP (US), Dallas, Texas; Paul K. Sun, Jr., Kelly Margolis Dagger, 

ELLIS & WINTERS LLP, Raleigh, North Carolina, for Appellant. Chad D. Hansen, 

Whitney R. Pakalka, KILPATRICK TOWNSEND & STOCKTON LLP, Winston-Salem, 

North Carolina, for Appellee.

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 1 of 18
2

Unpublished opinions are not binding precedent in this circuit.

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 2 of 18
3

AGEE, Circuit Judge:

Senderra RX Partners, LLC (“Senderra”) appeals the district court’s grant of 

summary judgment in favor of Blue Cross and Blue Shield of North Carolina (“Blue 

Cross”), arguing that the district court erred when it concluded that Senderra was not 

aggrieved by Blue Cross’ purported violations of the North Carolina Pharmacy of Choice 

statute. Finding no error, we affirm. 

I.

A.

Blue Cross is an insurer whose operations include a specialty pharmacy network 

(“the Network”) in North Carolina.1 To join the Network, prospective pharmacies must 

complete both a credentialing and contracting process. Blue Cross’ website includes 

instructions on the credentialing process, which requires that the pharmacy obtain, as 

relevant here, a pharmacy permit issued by the North Carolina Board of Pharmacy 

(“NCBOP permit”) as required under North Carolina law, see N.C. Gen. Stat. § 90-

85.21(a); 21 N.C. Admin. Code 46.1401(a), and an accreditation certificate from the 

Utilization Review Accreditation Commission (“URAC accreditation”).2 The contracting 

1 Given the standard on summary judgment, we recite the facts in the light most 

favorable to the non-moving party, Senderra. Garofolo v. Donald B. Heslep Assocs., Inc., 

405 F.3d 194, 198 (4th Cir. 2005).

2 “URAC is an independent body that accredits specialty pharmacies and other 

healthcare entities.” J.A. 466. Blue Cross required URAC accreditation because it was 

“considered the gold standard for specialty pharmacies . . . . It ensures that the specialty 

pharmacy meets a rather rigorous set of standards for quality.” J.A. 509. 

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 3 of 18
4

process then “confirms that each specialty pharmacy applying to join the Network meets 

the applicable contract requirements and secures the pharmacy’s agreement to the 

contractual terms that will govern its participation in the Network.” J.A. 308. Those terms 

are included in a Network Participation Agreement (“NPA”). 

In 2018, Blue Cross updated the terms of the Network and, among other changes,

replaced the requirement that participating pharmacies maintain a staffed business office

in North Carolina with a requirement that there be a dispensing pharmacy location in North 

Carolina (“dispensing-location term”). Blue Cross then solicited from its existing Network 

members applications to join this new specialty pharmacy network. Its solicitation

specified that “pharmacies that d[id] not meet the requirements for participation in the new 

specialty pharmacy network w[ould] receive [a] notice of removal” from it. J.A. 672. 

Interested pharmacies had to “submit all necessary paperwork that [Blue Cross] require[d]

by [October 1] for a [January 1] entry date.” J.A. 713.

Along with this solicitation, the participating pharmacies received the updated NPA 

and NPA Addendum (“Addendum”). Those materials identified the new dispensinglocation term, as well as the licensing, certification, and accreditation requirements. 

Specifically, the Addendum indicated that the pharmacies “must have a dispensing location 

within the state of North Carolina.” J.A. 713. The Addendum also detailed that each 

pharmacy must “maintain [URAC] Specialty Pharmacy accreditation and provide proof 

thereof.” J.A. 709. In addition, the NPA established that the participating pharmacies must 

hold the necessary licensing and certification “under North Carolina and any other 

applicable law.” J.A. 687. Finally, the NPA referenced “Policies and Procedures” that were 

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 4 of 18
5

listed on Blue Cross’ website, J.A. 689, which explained that each specialty pharmacy 

location was required to hold an NCBOP permit and URAC accreditation, as well as the 

Provider Manual, which detailed the credentialing process.

In actual application, Blue Cross permitted pharmacies to satisfy the dispensinglocation term through a corporate affiliate,

3 but did not expressly offer pharmacies this 

option. Instead, “[w]hen a pharmacy communicated their intent to satisfy [the dispensinglocation term] through corporate affiliation[,] [Blue Cross] discussed with them . . . how to 

go about doing that.” J.A. 1139.

B.

Senderra is a Texas-based specialty pharmacy that first applied to join the Network 

in 2013. After initially submitting an insufficient application for lack of proof of an 

NCBOP permit or URAC accreditation, it was admitted into the Network in 2015.

Senderra received Blue Cross’ updated Network materials on May 3, 2018, 

acknowledging on May 7, 2018, that it likely “ha[d] to go through a whole new application 

process to be in [Blue Cross’] new Statewide Specialty Pharmacy Network.” J.A. 374.

Senderra’s “biggest concern [was] the dispensing location within [North Carolina].” J.A. 

373. Because it only had “a staffed business office” in North Carolina, id., it recognized 

that the dispensing-location term “w[ould] preclude [it] from being able to qualify under 

the new terms and conditions and w[ould] result in its termination from the specialty 

3 Corporate affiliate agreements involve “the parent or umbrella organization . . . 

contract[ing] with a payer on behalf of all of those locations or entities within its structure.” 

J.A. 871. 

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 5 of 18
6

network,” J.A. 755. Nonetheless, Senderra “decided to apply into the network first and get 

an anticipated rejection letter.” J.A. 761. 

Senderra submitted its application on June 1, 2018. After Blue Cross confirmed that 

Senderra only had a staffed business office in North Carolina, it sent Senderra a termination 

letter dated July 11, 2018, stating that Senderra’s NPA would terminate effective October 

15, 2018, for failure to “satisfy the requirements for continued participation in [the 

Network].” J.A. 173. 

Upon receipt of this letter, Senderra contacted Blue Cross “to inquire about . . . the 

reason for termination,” J.A. 638, although it “assum[ed]” it had been terminated due to its 

lack of a dispensing location in North Carolina, J.A. 639. As Blue Cross confirmed on July 

26, 2018, Senderra was noticed for termination because it “did not have a dispensing 

location within North Carolina.” J.A. 30. 

Senderra subsequently obtained a physical dispensing location in North Carolina 

and submitted a new application on September 14, 2018, stating that it had “a dispensing 

pharmacy location address in [North Carolina] to fully satisfy the requirements for 

participation in the new specialty network.” J.A. 183. However, the location did not possess

an NCBOP permit as required by North Carolina law. In response, on September 18, 2018, 

Blue Cross informed Senderra that “[o]nce th[e] new pharmacy location [was]

credentialed, provided all other requirements [were] satisfied, the new site [would] be 

included as a dispensing location on the new contract.” J.A. 195. But Senderra did not 

timely obtain an NCBOP permit for that location, so its NPA was terminated effective 

October 15, 2018, as originally scheduled. 

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 6 of 18
7

While Blue Cross terminated Senderra from the Network for failure to comply with 

the dispensing-location term, Blue Cross learned during the underlying litigation that it

“inadvertently” allowed two pharmacies—Avita Pharmacy (“Avita”) and Long’s Drugs

(“Long’s”), both of which had existing permitted dispensing locations in North Carolina—

to execute new NPAs despite their dispensing locations lack of URAC accreditation. J.A. 

470. As a result, Blue Cross “noticed both pharmacies for contract termination.” J.A. 255. 

But when the pharmacies notified Blue Cross that “they intended to exercise their right to 

cure” under the terms of the new NPA and requested an extension to do so, Blue Cross 

granted the requests.

4 J.A. 529–30. In contrast, Blue Cross denied Senderra such an

extension because Senderra was fundamentally ineligible to execute the new NPA due to 

its lack of a permitted dispensing location, meaning it could not invoke the right-to-cure 

provision. See J.A. 534 (Blue Cross’ Rule 30(b)(6) witness explaining that Avita and 

Long’s “had a North Carolina pharmacy. It was not a credentialed one. But it was a 

location, a dispensing location[, so] they were allowed to contract. . . . [Whereas Senderra] 

didn’t even have any [dispensing] location in North Carolina that—you know credentialed 

or uncredentialed”); J.A. 1210 (relaying that Blue Cross “allowed Long’s Drugs and Avita 

additional time to cure their breaches of the NPAs because . . . [they] were not at fault for 

[Blue Cross] inadvertently failing to ensure they were fully credentialed before offering 

4 In a similar vein, Senderra permitted AllianceRX, which also had a permitted 

dispensing location in North Carolina, to execute the new NPA past the October 2018 

deadline in December 2018.

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 7 of 18
8

them an NPA and [Blue Cross] felt it would be unfair and inequitable to punish [them] for 

[Blue Cross’] inadvertence”). 

Senderra ultimately obtained an NCBOP permit for its North Carolina dispensing 

location on November 5, 2018, and URAC accreditation on March 12, 2019 (both well 

after the October 15, 2018, deadline). It then reapplied for admission into the Network and 

executed a new NPA on March 30, 2019, with an effective date of July 1, 2019. As a result 

of Senderra’s exclusion from the Network, its expert estimated a loss of $13,999,315.33 in 

revenue and $232,476.57 in profits. Senderra’s expert also projected that Senderra would 

incur further damages for up to five years after its readmittance. 

C.

On October 15, 2018, Senderra filed suit against Blue Cross, asserting violations of 

the North Carolina Pharmacy of Choice statute (“NCPOC statute”), N.C. Gen. Stat. § 58-

51-37, and Article 1 of the North Carolina Unfair and Deceptive Trade Practices Act 

(“NCUDTPA”), N.C. Gen. Stat. § 75-1.1, and for breach of the NPA. After Blue Cross 

informed Senderra that it inadvertently admitted Avita and Long’s into the Network, 

Senderra amended its complaint to include, as relevant here, a claim of fraud.5

Blue Cross subsequently moved to dismiss Senderra’s amended complaint, which 

the district court granted in part and denied in part. At the close of discovery, Blue Cross 

moved for summary judgment on the remaining claims, and the district court granted the

motion. As for Senderra’s claim under the NCPOC statute, while the court recognized that 

5 While Senderra’s amended complaint included its original claims under the 

NCPOC statute and the NCUDTPA, it did not raise a claim for breach of the NPA. 

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 8 of 18
9

“[n]o court ha[d] clearly set forth the elements of ‘a violation of this section’ or defined 

when a pharmacy is ‘aggrieved by such a violation,’” the court reasoned that it was 

elementary that Senderra show it was aggrieved by Blue Cross’ actions. J.A. 1575. The 

court concluded that Senderra could not do so because

all the evidence show[ed] that [Blue Cross] made its terms available to 

Senderra through mailings and its website, that Senderra knew [Blue Cross] 

required an in-state dispensary, and that Senderra did not have an operational 

in-state dispensing pharmacy when it applied to participate in the new 

network in June or when the old contract expired. Thus, Senderra did not 

meet a clearly communicated term required by [Blue Cross.]

J.A. 1576–77. 

The court recognized that even though Senderra asserted it was unaware of Blue 

Cross’ credentialing requirement until October 2018, “Senderra was not aggrieved by that 

purported violation because Senderra had not met the preliminary requirement of having a 

permitted in-state dispensing pharmacy.” J.A. 1577. And although Senderra challenged 

Blue Cross’ failure to inform it of the option to satisfy the dispensing-location term by 

corporate affiliate, the court explained that the NCPOC statute “requires [Blue Cross] to 

make its terms available to interested pharmacies, not walk the pharmacy through how to 

meet those terms.” Id. Finally, the court found unavailing Senderra’s argument that Blue 

Cross improperly admitted Avita and Long’s despite the fact that their dispensing locations 

lacked URAC accreditation, reasoning that

[t]his d[id] not matter, as Senderra did not have a permitted in-state 

dispensary. Assuming [Blue Cross] violated the statute by inadvertently 

offering different terms to different pharmacies, Senderra was not aggrieved 

by that violation since it did not meet the basic term imposed on all 

pharmacies and met by every pharmacy admitted into the network.

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 9 of 18
10

J.A. 1578. 

As for the fraud claim, the court found that Senderra could neither demonstrate 

reasonable reliance on the purported misrepresentations nor cognizable harm from them. 

Finally, the court determined that the NCUDTPA claim failed for the same reasons the 

other claims failed.

Senderra timely noted an appeal, over which we have jurisdiction pursuant to 28 

U.S.C. § 1291.

II.

“We review a district court’s decision to grant summary judgment de novo, applying 

the same legal standards as the district court, and viewing all facts and reasonable 

inferences therefrom in the light most favorable to the nonmoving party.” Carter v. 

Fleming, 879 F.3d 132, 139 (4th Cir. 2018) (citation omitted). Summary judgment is 

appropriate “if the movant shows that there is no genuine dispute as to any material fact 

and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). 

III.

As a preliminary matter, Blue Cross asserts that Senderra lacks Article III standing 

because it cannot demonstrate that any injury it sustained was “fairly traceable to the 

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 10 of 18
11

challenged action of the defendant.”6 Friends of the Earth, Inc. v. Laidlaw Env’t Servs. 

(TOC), Inc., 528 U.S. 167, 180 (2000) (citing Lujan v. Defs. of Wildlife, 504 U.S. 555, 560–

61 (1992)). In other words, Blue Cross avers that Senderra effectively caused its own 

injury, as its failure to comply with the fundamental requirements of the dispensinglocation term—namely, to establish a permitted dispensing location in North Carolina—

led to its termination from the Network.

But Senderra alleges its injury was due to myriad circumstances fairly traceable to 

Blue Cross, including, among other allegations, that Blue Cross “fail[ed] to provide 

sufficient information as to the various requirements for a dispensing location,” issued 

“vague, incomplete and conflicting” instructions on how to satisfy them, and enforced them

with “unequal force and manner.” J.A. 1569–70 (citation omitted). Compare with GBA 

Assocs. v. Gen. Servs. Admin., 32 F.3d 898, 901 (4th Cir. 1994) (reasoning that the plaintiff 

lacked standing solely due to its own shortcomings, which “br[oke] the chain of causation 

and divest[ed] [it] of standing”). Senderra’s injury is therefore at least fairly traceable to 

Blue Cross’ actions. See Sierra Club v. U.S. Dep’t of the Interior, 899 F.3d 260, 284 (4th 

Cir. 2018) (explaining that the causation element “does not require the challenged action 

to be the sole or even immediate cause of the injury”). Accordingly, we are satisfied that 

Senderra meets the causation element of Article III standing to proceed with its claims 

against Blue Cross. 

6 Although Article III standing was not raised below, we consider it here because

we “have an independent obligation to ensure that [we] do not exceed the scope of [our] 

jurisdiction.” Henderson ex rel. Henderson v. Shinseki, 562 U.S. 428, 434 (2011).

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 11 of 18
12

IV.

On appeal, Senderra contends that the district court erred when concluding that it 

was not aggrieved by Blue Cross’ alleged violations of the NCPOC statute. While the 

parties spar over the legal framework under which this argument should be housed, 

invoking concepts such as statutory standing and proximate cause in the process, we find 

Senderra’s core argument unpersuasive in any event. We therefore perceive no error in the 

district court’s determination that Senderra was not aggrieved by Blue Cross’ actions. 

Senderra alleges that Blue Cross violated three provisions of the NCPOC statute’s 

subsection (c), which direct that “the terms of a health benefit plan shall not”:

(1) Prohibit or limit a resident of this State . . . from selecting a pharmacy of 

his or her choice when the pharmacy has agreed to participate in the health 

benefit plan according to the terms offered by the insurer;

(2) Deny a pharmacy the opportunity to participate as a contract provider 

under a health benefit plan if the pharmacy agrees to provide pharmacy 

services that meet the terms and requirements . . . of the insurer under a health 

benefit plan . . . ; [or]

(4) Impose a monetary advantage or penalty under a health benefit plan that 

would affect a beneficiary’s choice of pharmacy[.]

N.C. Gen. Stat. § 58-51-37(c)(1), (2), (4). Relevant here, “[a] violation of this section 

creates a civil cause of action for damages or injunctive relief in favor of any person or 

pharmacy aggrieved by the violation.” Id. § 58-51-37(h). 

While the parties contest the applicability of subsection (c) of the NCPOC statute to 

Senderra’s claims (with Blue Cross asserting that subsection (e) of that statute controls), 

we need not resolve the issue. Assuming, without deciding, that Senderra’s claims can be 

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 12 of 18
13

housed under subsection (c), Senderra has failed to establish it was aggrieved by Blue 

Cross’ actions. We thus address the relevant provisions of subsection (c) in turn. 

A.

Senderra first argues that Blue Cross violated subsections (c)(1) and (2) of the 

NCPOC statute, which can protect pharmacies that have agreed to, and comply with, the 

terms required by the insurer. Senderra fails to qualify as such a pharmacy for the reasons 

cited by the district court—namely, that Senderra did not satisfy the NPA’s threshold 

requirement to establish a permitted dispensing location in North Carolina before the 

October 2018 termination deadline. 

To start, the record reflects that the materials Senderra received from Blue Cross on 

May 3, 2018, enumerated that a physical dispensing location in North Carolina was 

required to participate in the new Network. Senderra was expressly aware of this new term–

–in fact, it was Senderra’s “biggest concern” when it came to the new Network. J.A. 373.

Moreover, Senderra was (or should have been) aware of the permitting aspect of the 

dispensing-location term as it was required by North Carolina law. See N.C. Gen. Stat. § 

90-85.21(a); 21 N.C. Admin. Code 46.1401(a). Its argument to the contrary borders on 

nonsensical. As a sophisticated entity, Senderra cannot claim ignorance of such a standard 

state-imposed requirement, particularly when it had previously submitted an application 

for admission into the Network in 2013 that was deemed insufficient for lack of an NCBOP 

permit. As the district court remarked on this point, “Why would anybody who runs a 

pharmacy think that [it] would suffice to have a pharmacy that couldn’t actually dispense 

drugs for prescriptions?” J.A. 1543. Not to mention, the materials Senderra received from 

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 13 of 18
14

Blue Cross in May 2018 contained general information on holding the necessary licensing 

and certification “under North Carolina and any other applicable law,” J.A. 687, and 

referenced “Policies and Procedures” that were listed on Blue Cross’ website, J.A. 689, 

which explained that each specialty pharmacy location was required to hold an NCBOP 

permit.

Despite the clarity of these requirements, at no time prior to the October 2018 

deadline did Senderra establish a permitted dispensing location in North Carolina, a fact 

which it conceded during oral argument. Oral Argument at 9:54–10:05, Senderra RX 

Partners, LLC v. Blue Cross & Blue Shield of N.C. (No. 21-1549) (4th Cir. May 4, 2022), 

https://www.ca4.uscourts.gov/OAarchive/mp3/21-1549-20220504.mp3 (Senderra 

conceding that it “did not have the in-state dispensing location requirement met by October 

15 as it was ultimately required by Blue Cross”). And on this basis, Blue Cross terminated 

Senderra from the Network. Because Senderra failed to comply with required components 

of the dispensing-location term, it cannot claim protection under subsections (c)(1) and (2) 

of the NCPOC statute as an aggrieved party as if it had complied with those provisions. 

Senderra raises three primary arguments in response, none of which is persuasive.

First, it claims that the new NPA and Addendum did not clearly convey that the North 

Carolina dispensing location needed to be credentialed. But this point is immaterial to 

Senderra’s case because, as discussed above, it was unable to establish a permitted 

dispensing location. That is to say, whether Senderra could have hypothetically met the 

credentialing requirement is irrelevant, as it had yet to establish a permitted dispensing 

location in North Carolina by the October deadline.

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 14 of 18
15

Next, Senderra asserts that Blue Cross’ treatment of Avita, Long’s, and AllianceRX 

evinces Blue Cross’ disparate conduct towards Senderra because Avita and Long’s 

executed the new NPA despite their permitted dispensing locations in North Carolina lack 

of URAC credentialing and were granted an extension to cure that defect, and AllianceRX 

signed its new NPA after the October deadline in December 2018. But the circumstances 

of these pharmacies are not analogous to those of Senderra. Avita, Long’s, and AllianceRX 

all had timely permitted dispensing locations in North Carolina, a fact which Senderra 

acknowledged during oral argument. Id. at 10:30–10:43 (Senderra conceding that these 

three pharmacies “had an actual physical location” in North Carolina “that could dispense 

drugs,” and that Senderra did not). In other words, no pharmacy was admitted to the 

Network without a permitted dispensing location, which Senderra undeniably lacked. So, 

while Senderra makes much of Blue Cross’ treatment of Avita, Long’s, and AllianceRX, 

their respective positions were fundamentally distinguishable from that of Senderra.

Lastly, Senderra argues that Blue Cross should have made it aware that relying on

a corporate affiliate was an acceptable alternative mode of fulfilling the dispensing-location 

term. But the record establishes that Blue Cross did not offer this option to any pharmacy. 

J.A. 1139 (explaining that Blue Cross “did not proactively raise . . . ways to satisfy the 

requirement with any pharmacy”). Rather, “[w]hen a pharmacy communicated their intent 

to satisfy [the dispensing-location term] through corporate affiliation[,] [Blue Cross] 

discussed with them . . . how to go about doing that.” Id. Quite simply, Senderra did not 

ask Blue Cross about this option, so Blue Cross did not explain how to utilize it. Senderra 

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 15 of 18
16

was therefore on equal footing with the other specialty pharmacies, as it should have 

inquired about this option if it intended to rely on it.

To obtain the protection of subsection (c)(1) or (2), Senderra had to comply with 

“the terms offered by the insurer” and “meet the terms and requirements . . . of the insurer.” 

N.C. Gen. Stat. § 58-51-37(c)(1)–(2). Having failed to demonstrate that it complied with 

the insurer’s fundamental condition precedent of the dispensing-location term, Senderra 

cannot make a claim under subsections (c)(1) and (2) of the NCPOC statute.

B.

Next, Senderra claims that Blue Cross violated subsection (c)(4) of the NCPOC 

statute, which directs that the terms of a health benefit plan shall not “[i]mpose a monetary 

advantage or penalty . . . that would affect a beneficiary’s choice of pharmacy.” Id. § 58-

51-37(c)(4). Specifically, Senderra argues that Blue Cross effectively granted certain 

pharmacies a monetary advantage when it permitted them to remain in the new Network 

despite their lack of credentialing (Avita and Long’s) or a timely executed NPA 

(AllianceRX). For the reasons explained by the district court, Senderra’s claim on this point 

fails as well.

At bottom, Senderra does not fall within the class of claimants this provision 

protects. The examples of “monetary advantage or penalty” cited in subsection (c)(4) make 

clear that it protects pharmacies within the Network. Said another way, “higher copayment, 

a reduction for reimbursement for services, or promotion of one pharmacy over another”

are all advantages or penalties that only participating pharmacies would face. Id. But unlike 

Avita, Long’s, and AllianceRX, Senderra was not a participating pharmacy in the new 

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 16 of 18
17

Network due to its termination for failure to establish a permitted dispensing location. 

Therefore, it fails to qualify within the class protected by this subsection, meaning it cannot 

claim it was aggrieved by Blue Cross’ conduct.

V.

Finally, Senderra contests the district court’s grant of summary judgment in favor 

of Blue Cross on its fraud and alleged NCUDTPA violation. Assuming arguendo that Blue 

Cross engaged in misrepresenting or concealing the credentialing component of the 

dispensing-location term, Senderra cannot demonstrate that this conduct caused its injury. 

Ragsdale v. Kennedy, 209 S.E.2d 494, 500 (N.C. 1974) (enumerating the elements to 

establish a claim for fraud).

7 As discussed above, Blue Cross terminated Senderra from the 

Network for failure to establish a permitted dispensing location in North Carolina, meaning 

Senderra’s exclusion was unrelated to Blue Cross’ representation of the credentialing 

component. Accordingly, the district court properly granted summary judgment in favor of 

Blue Cross on Senderra’s fraud claim. And because Senderra recognizes that its alleged 

NCUDTPA violation rises and falls with its other claims, we likewise conclude that 

summary judgment was proper as to that claim.

VI.

For the reasons discussed above, the judgment of the district court is 

7 Because we sit in diversity in this case, North Carolina law applies. S. Power Co. 

v. Cleveland Cnty., 24 F.4th 258, 262 (4th Cir. 2022).

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 17 of 18
18

AFFIRMED.

USCA4 Appeal: 21-1549 Doc: 46 Filed: 06/01/2022 Pg: 18 of 18