CONTRACT NUMBER: SUBRECIPIENT * N19069 YES NO FFATA FORM REQUIRED PERSONAL SERVICE YES NO YES NO * see Attachment 2 THIS AGREEMENT is made by and between the state of Washington Department of Health, hereinafter referred to as DOH, and the party whose name appears below, hereinafter referred to as the Contractor. CONTRACTOR NAME and ADDRESS: Ramsell Public Health Rx, LLC 200 Webster Street, Suite 200 Oakland, CA 94607 UBI #: 602-114-176 IT IS MUTUALLY AGREED THAT: PURPOSE: The purpose of this contract is to provide pharmacy benefits management services for clients of the DOH Early Intervention Program. STATEMENT OF WORK: The Contractor shall provide the all necessary personnel, equipment, materials, goods and services and otherwise do all things necessary for or incidental to the performance of the work as described in Exhibit A, attached hereto and incorporated herein. PERIOD OF PERFORMANCE: Subject to its other provisions, the period of performance under this contract shall be from January 1, 2012 through June 30, 2013 unless sooner terminated as provided herein. No billable activity may take place until this contract has been signed by both parties. DEPARTMENT OF ENTERPRISE SERVICES APPROVAL: In the event this agreement is designated above as a personal service: Under the provisions of Chapter 39.29 RCW, personal services contract(s) and amendments may be required to be filed with the Department of Enterprise Services (DES) for approval. No contract or amendment required to be so filed is effective and no work thereunder shall be commenced nor payment made therefore until ten (10) working days following the date of filing, and, if required, until approved by DES. In the event DES fails to approve the contract or amendment, the contract shall be null and void. FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA): If checked above, this contract is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how federal funds are spent. To comply with the act and be eligible to enter into this contract, your organization must have a Data Universal Numbering System (DUNS®) number. A DUNS® number provides a method to verify data about your organization. If you do not already have one, you may receive a DUNS® number free of charge by contacting Dun and Bradstreet at www.dnb.com. Information about your organization and this contract will be made available on www.USASpending.gov by DOH as required by P.L. 109-282. DOH‘s form, Federal Funding DOH Contract N19069 Page 1 of 98 Ramsell Public Health Rx, LLC Accountability and Transparency Act Data Collection Form, is considered part of this contract and must be completed and returned along with the contract. CONSIDERATION: The maximum consideration available under this contract shall not exceed $1,875,000.00 without a properly executed written amendment signed by representatives of both parties authorized to do so. Source of funds: Federal: $-0- State: $1,875,000 Other: $-0- Total: $1,875,000 Federal funding for this contract were received by DOH through OMB Catalogue of Federal Domestic Assistance Number: N/A. Contractor agrees to comply with all applicable rules and regulations associated with these funds. Unless otherwise indicated in this contract, any state funds which are unexpended as of June 30th will not be available for carry over into the next state fiscal year (July – June). INVOICES AND PAYMENT: Contractor will submit invoices to the DOH Project Manager for all amounts to be paid. Invoices must reference this contract number and provide detailed information as requested. All invoices must be approved by DOH prior to payment; approval will not be unreasonably withheld. DOH will authorize payment only upon satisfactory completion and acceptance of deliverables and for allowable costs as outlined in the statement of work and/or budget. DOH will return all incorrect or incomplete invoices and will not pay for services that occur outside the period of performance. The Contractor will not invoice for services if they are entitled to payment, have been, or will be paid by any other source for that service. DOH will issue payment within 30 days of receiving a correct and complete invoice and approving the deliverable(s). DOH must receive correct and complete invoices within 60 days of the contract expiration date. Late invoices will be paid at the discretion of DOH and are contingent upon the availability of funds. Failure to submit a properly completed IRS form W-9 may result in delayed payments. GOVERNANCE: In the event of an inconsistency in this contract, unless otherwise provided herein, the inconsistency shall be resolved by giving precedence in the following order: Applicable Federal and State statutes and regulations Special Terms and Conditions Attachment 1, General Terms and Conditions Exhibit A, Statement of Work Any other provision of the contract whether incorporated by reference or otherwise. UNDERSTANDING: This contract, including referenced exhibits, attachments & documents included herein by reference, contains all the terms and conditions agreed upon by the parties. No other understandings, oral or otherwise, regarding the subject matter of this contract shall exist or bind any of the parties hereto. APPROVAL: This contract shall be subject to the written approval of DOH Contracting Officer and shall not be binding until so approved. Only the Contracting Officer or his/her designee, by written delegation made prior to action, shall have the expressed, implied, or apparent authority to alter, amend, modify, or waive any clause or condition of this contract. Furthermore, any alteration, amendment, modification, or waiver of any clause or condition of this contract is not effective or binding unless made in writing and signed by the Contracting Officer. DOH Contract N19069 Page 2 of 98 Ramsell Public Health Rx, LLC IN WITNESS WHEREOF: DOH and the Contractor have signed this agreement. CONTRACTOR SIGNATURE DATE print or type name & title below: DOH CONTRACTING OFFICER SIGNATURE DATE This contract has been approved as to form by the attorney general. NOTE: THE CONTRACTOR‟S SIGNATURE IS ALSO REQUIRED ON ATTACHMENT 2, FEDERAL CERTIFICATIONS AND ASSURANCES (pages 88 and 91) DOH Contract N19069 Page 3 of 98 Ramsell Public Health Rx, LLC EXHIBIT A STATEMENT OF WORK DOH Contract #N19069 Exhibit A – Statement of Work Communications In written/fax/email/web communication with pharmacies, the Contractor will refer to this program as the Washington State Department of Health HIV Early Intervention Program (EIP). In written/fax/email/web communication with clients, the Contractor will refer to this program as Early Intervention Program (EIP). In all communication with pharmacies, clients, and others, the contractor will refer to itself as Ramsell Public Health Rx, or Ramsell. Pharmacy network The Contractor will establish and maintain a statewide pharmacy network to serve DOH clients comparable to Exhibit C, WA Statewide Pharmacy Network, which includes the following: 1. Over-the-counter (chain store and independent pharmacies) 2. Institutional (i.e. University based hospitals, county hospitals, Health Maintenance Organizations such as Group Health or Kaiser) 3. Specialty (i.e. HIV targeted services) 4. Mail order The Contractor will maintain an open enrollment process that will allow additional pharmacies to enter the network that meet the following criteria: 1) Have no licensure encumbrance by any state or federal law; 2) Have a license issued by the residing State; and 3) Be willing to accept reimbursement provided by the Contractor. In the open enrollment process, pharmacies enter a contractual agreement with the Contractor. The contract will stipulate that pharmacy providers are independent contractors. As independent contractors, the Contractor will not supervise, direct or otherwise intervene in their provision of pharmacy services. The contract shall also state that providers must operate in compliance with service standards, maintain adequate inventory, and fill prescriptions promptly. The pharmacies must maintain insurance and hold the Contractor and DOH harmless and maintain adequate insurance. The contractual agreement between the Contractor and the pharmacies will include the following language regarding the Hold Harmless clause and insurance: Hold Harmless The Provider shall look only to Ramsell for compensation for services rendered to a Member for covered services under a SPONSOR Agreement. The Provider agrees not to bill, charge, collect a deposit from, seek compensation from, seek remuneration from, surcharge or have any recourse against Member or persons acting on behalf of Member (other than Ramsell), except to the extent that shares of cost are specified in the applicable SPONSOR Agreement. Provider agrees not to maintain any action at law or in equity against a Member to collect sums that are owed by Ramsell to Provider under the terms of this Agreement, even in the event Ramsell fails to pay, becomes insolvent or otherwise breaches the terms and conditions of this Agreement. This section shall survive termination of this Agreement and shall be construed to be for the benefit of Members. This section is not intended to apply to services provided after this Agreement has been terminated, except as otherwise provided in this Agreement, or with respect to non-covered services. The Provider further agrees that this provision supersedes any oral or written agreement, hereinafter entered into between Provider and Member or persons DOH Contract N19069 Page 4 of 98 Ramsell Public Health Rx, LLC EXHIBIT A STATEMENT OF WORK acting on Member's behalf, insofar as such agreement relates to payment for services provided under the terms and conditions of this Agreement. Pharmacy Liability Insurance Provider shall furnish and keep in full force and effect at all times during the term of this Agreement, the following insurance or, if self-insured provide to Ramsell written representations or certificates of such self-insurance satisfactory to Ramsell: A.