0256-K.pdf

RFP 0256-K, Page 1 of 19

BOILERPLATE

REVISED SEPTEMBER 2022

STATE OF WYOMING

DEPARTMENT OF ADMINISTRATION & INFORMATION

GENERAL SERVICES DIVISION, PROCUREMENT SECTION

2323 CAREY AVENUE

CHEYENNE, WY 82002

REQUEST FOR PROPOSAL NUMBER 0256-K

WYOMING DEPARTMENT OF HEALTH

WYOMING RETIREMENT CENTER

PHARMACEUTICAL SERVICES

PROPOSAL DUE DATE AND TIME

JUNE 23, 2025 – 2:00:00 P.M. MOUNTAIN TIME

AGENCY REPRESENTATIVE:

CHRISTINA ANDERSON

PROCUREMENT REPRESENTATIVE:

DEBI WALKER

debi.walker@wyo.gov

(307) 777-6707

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Table of Contents

SECTION 1: REQUEST FOR PROPOSAL

SECTION 2: GENERAL PROVISIONS

SECTION 3: SPECIAL PROVISIONS INFORMATION

SECTION 4: KEY DATES

SECTION 5: ADMINISTRATIVE BACKGROUND

SECTION 6: REQUIREMENTS/SPECIFICATIONS

SECTION 7: PROPOSAL SUBMISSION REQUIREMENTS

SECTION 8: EVALUATION METHODOLOGY

SECTION 9: PROPOSAL PRICE SHEET AND SIGNATURE PAGE

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK.

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SECTION 1: REQUEST FOR PROPOSAL

1. SUBMISSION OF PROPOSALS:

The A&I Procurement Office will receive proposals for providing pharmaceutical services for the State of

Wyoming, Department of Health, Wyoming Retirement Center (Agency) through the Public Purchase online bidding system. Proposals are due no later than 2:00:00 P.M. (Mountain Time) on June 23, 2025.

The technical proposal and cost proposal should be uploaded as separate documents and identified as such.

1.1. Proposals should be accompanied by the attached Proposal Price Sheet and signed by the proper official of the firm. All proposals should be uploaded on the Public Purchase online bidding system. Proposals sent by facsimile, email or paper copy may be rejected.

1.2. Proposals should be submitted through the Public Purchase online bidding system on or before the date and time specified. Proposals received after the date and time specified may be rejected.

1.3. The State of Wyoming reserves the right to withdraw this Request for Proposal, without cause, at any time before a contract has been fully signed and submitted to the A&I Procurement Office.

2. MODIFICATIONS OR WITHDRAWAL OF PROPOSALS:

2.1. A proposal may be altered through the Public Purchase online bidding system before the proposal due date and time contained in this document.

2.2. The proposer may withdraw its proposal through the Public Purchase online bidding system up to the proposal due date and time contained in this document. If a proposal is accepted and the proposer fails to furnish the service agreed upon in the proposal, that proposer may be eliminated from future consideration.

3. PREPARATION OF PROPOSALS:

3.1. A proposal may be rejected if it modifies any of the provisions, specifications or minimum requirements of the Request for Proposal.

3.2. In case of error in the extension of prices in the proposal, unit prices will govern.

4. AWARD AND CONTRACT INFORMATION:

4.1. The State of Wyoming will ensure that minority business enterprises will be afforded full opportunity to submit proposals. The State of Wyoming will not discriminate on the grounds of age, race, color, sex, creed, national origin, or disability status.

4.2. The proposer also, agrees that should their firm be awarded a contract, it will not discriminate against any person who performs work there under because of age, race, color, sex, creed, national origin or disability. In addition, the successful proposer shall comply with the Americans with

Disability Act and the Wyoming Fair Employment Practices Act.

4.3. The proposer expressly warrants to the State that it has the ability and expertise to perform the contract if awarded. In doing so, it shall use the highest standards of professional workmanship.

4.4. The State of Wyoming reserves the right to reject any or all proposals, to waive any informality or technical defect in the proposals, or to award the contract in whole or in part, if deemed to be in the best interest of the State to do so. The A&I Procurement Office will award the contract to the firm, determined to have the most responsive and responsible proposal by the Department of

Health, Wyoming Retirement Center.

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4.5. The successful proposer will be required to agree to and execute a formal contract with the State containing terms required by the Attorney General with reasonable adjustments acceptable to the

State.

4.6. If applicable, the State will negotiate payment terms based upon a schedule to be determined by the proposer and the State. Paying invoices will be based upon the proposer successfully completing the deliverables within the stated deadlines, and upon the Agency’s written acceptance of the deliverables or services.

DATED: MAY 22, 2025

State of Wyoming

Procurement Section

Buyer: Debi Walker

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SECTION 2: GENERAL PROVISIONS

1. INSURANCE:

1.1. The contract between the successful proposer and the State shall require the successful proposer to carry certain insurance policies. All such insurance policies, except workers’ compensation and unemployment compensation policies, shall contain a waiver of subrogation against the Agency and the State, its agents and employees.

2. LAWS TO BE OBSERVED:

2.1. The proposer shall keep fully informed of, and comply with, all applicable federal and state laws or rules, all local bylaws, regulations and all orders and decrees of bodies or tribunals having any jurisdiction or authority. The proposer shall protect and indemnify the State and its representatives against any claim or liability arising from or based on the violation of any law, bylaw, ordinance, regulation, order or decree whether by himself or its employees.

3. ASSIGNMENT:

3.1. The proposal shall not be assigned by the proposer. Third party participation is authorized only as a joint venture that shall be clearly stated in detail in the original proposal and signed by all parties participating.

3.2. The proposer shall not enter into any subcontracts for any of the work contemplated under this

Request for Proposal without the State’s prior written authorization.

4. EXTENSION AND AMENDMENT:

4.1. The proposer and the State covenant and agree that this proposal or subsequent contract may, with the mutual approval of the proposer and the State, be extended two years at a time, for a total contract period not to exceed six (6) years.

5. AUDIT AND ACCESS TO RECORDS:

5.1. The State or any of its duly authorized representatives shall have access to the proposer’s books, documents, papers, electronic data and records that are directly pertinent to this Request for

Proposal.

6. CONFLICT OF INTEREST:

6.1. The proposer warrants that no kickbacks, gratuities, or contingency fees have been paid in connection with this Request for Proposal and none have been promised. The proposer warrants that no one being paid pursuant to the proposal is engaged in any activity that would constitute a conflict of interest with respect to the purchases of the proposal.

7. NO FINDER’S FEE:

7.1. The proposer warrants that no finder’s fee, employment agency fee, or any such fee related to the proposal shall be paid.

8. SOVEREIGN IMMUNITY:

8.1. Pursuant to Wyoming Statute § 1-39-104(a), the State of Wyoming and the Agency expressly reserve sovereign immunity and specifically retain all immunities and defenses available to them as sovereigns. The proposer acknowledges that the State of Wyoming has sovereign immunity and only the Wyoming Legislature has the power to waive sovereign immunity. Designation of

RFP 0256-K, Page 6 of 19 venue, choice of law, enforcement actions, and similar provisions shall not be construed as a waiver of sovereign immunity. The parties agree that any ambiguity in this Request for Proposal shall not be strictly construed, either against or for either party, except that any ambiguity as to sovereign immunity shall be construed in favor of sovereign immunity.

9. INDEMNIFICATION:

9.1. The proposer shall release, indemnify, and hold harmless the State, the Agency and its officers, agents, and employees from any and all claims, suits, liabilities, court awards, damages, costs, attorneys’ fees, and expenses arising out of the proposer’s failure to perform any of the proposer’s duties and obligations hereunder or in connection with the negligent performance of proposer’s duties and obligations, including, but not limited to, any claims, suits, liabilities, court awards, damages, costs, attorneys’ fees, and expenses arising out of proposer’s negligence or other tortious conduct.

10. APPLICABLE LAW/VENUE:

10.1. The construction, interpretation, and enforcement of this Request for Proposal shall be governed by the laws of the State of Wyoming, without regard to conflicts of law principles. The terms

“hereof,” “hereunder,” “herein,” and words of similar import, are intended to refer to this Request for Proposal as a whole and not to any particular provision or part.

11. RIGHT OF OWNERSHIP AND MARKETING OF INTELLECTUAL PROPERTY

AND INTELLECTUAL ASSETS SUBMITTED FOR THE RFP (IF APPLICABLE):

11.1. It is acknowledged and agreed that the only party with a right to market, trademark, patent, copyright, or any like right to any intellectual property or intellectual assets submitted in relation to the Request for Proposal shall be and is solely vested in the State. This includes all intellectual property and intellectual assets related to both the written proposal and the oral presentation and any and all documents, pitches, products, media pitches, web screens, layouts, etc. produced for the written proposal and the oral presentation, and any updates, changes, alterations, or modifications to or derivative works.

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SECTION 3: SPECIAL PROVISIONS INFORMATION

PROPOSALS SHOULD BE SUBMITTED THROUGH THE PUBLIC PURCHASE ONLINE BIDDING

SYSTEM BY 2:00:00 P.M. MOUNTAIN TIME ON JUNE 23, 2025. PROPOSALS RECEIVED AFTER

THE DATE AND TIME SPECIFIED MAY BE REJECTED.

It is the responsibility of the proposer to clearly identify all information that is considered confidential in accordance with the Wyoming Public Records Act, Wyoming Statute §16-4-201 through §16-4-205. Please identify each confidential page with the word “CONFIDENTIAL” in capital, bold letters centered at the bottom of each page. Information not clearly marked may be considered public. If the proposer submits information that it believes is confidential, it should include a statement justifying its basis for that belief.

1. STATE PARTIES:

1.1. This Request for Proposal is issued by the Wyoming Department of Administration and

Information, General Services Division, Procurement Section (Procurement) on behalf of the

Wyoming Department of Health, Wyoming Retirement Center (Agency).

1.2. Throughout this document and others in connection with this project, various references are made, or will be made to the “State.” Generally, whenever this reference appears, the term “State” incorporates all state agencies working on this project.

1.3. It should be understood that the Director of Wyoming Department of Health, Wyoming Retirement

Center is empowered to be the signatory on all contracts, agreements, or modifications pertaining to this project. Any contracts, agreements, or modifications not bearing this signature or that of a designee are invalid.

2. CONTENT AND PROCUREMENT POINTS OF CONTACT:

2.1. Procurement is the primary point of contact from the date of release of the Request for Proposal until a proposer is selected and the selection is announced.

2.2. Written questions about the procurement should be submitted through the Public Purchase online bidding system until 2:00:00 P.M. Mountain Time on June 9, 2025. Any questions received after that deadline may not be accepted or considered. Each question should be submitted individually.

It is the proposer’s responsibility to check the Public Purchase online bidding system for answers to questions, addenda, or bid tabulations. Telephone calls, emails or faxes may not be accepted.

2.3. Written responses will be available through the Public Purchase online bidding system. Responses will not identify the firm that submitted the question. Only the written answers issued by the

Agency are the official position on an issue, and these answers shall become part of the Request for Proposal.

3. RESTRICTIONS ON COMMUNICATIONS WITH AGENCY STAFF:

3.1. Until a proposer is selected and the selection is announced, proposers shall not communicate with

Agency staff except via written questions through the Public Purchase online bidding system.

3.2. If a proposer violates this restriction, the State reserves the right to reject the proposal.

4. EFFECTIVE DATES OF PROPOSAL:

4.1. All terms, conditions and costs quoted in the proposer’s response will be binding on the proposer for one-hundred eighty (180) days from the effective date of the proposal.

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5. ADVERTISING AWARD CONDITIONS:

5.1. A fully executed contract should be completed with the State before the successful proposer may advertise the award of the contract or the services being performed. The proposer should agree not to refer to awards in commercial advertising in such a manner that states or implies that the firm or its services are endorsed or preferred by the State of Wyoming.

6. CONTRACT NEGOTIATIONS:

6.1. The State will notify the most qualified/successful proposer and negotiate a contract in accordance with the Wyoming Attorney General’s contract guidelines. The successful proposer will be required to enter into and sign a formal contract with the Agency.

6.2. In the event the Agency determines contract negotiations are making no forward progress, negotiations will be terminated, and at the State’s sole discretion, negotiations may be initiated with the next most qualified/successful proposer, or the RFP may be withdrawn or reissued. This process will be followed until an agreement is reached, or until the State determines that the RFP will be withdrawn or reissued. The State assumes no obligation to a selected proposer until an agreement is reached and a contract is fully executed. The State will not negotiate concurrently with more than one proposer for the same award.

7. BEGINNING WORK:

7.1. The successful proposer may not perform any work that could be billed until a contract has been executed. The State will not pay for any work by the proposer before a contract is executed.

8. COPYRIGHT INFRINGEMENT:

8.1. The proposer warrants that no materials, products, and services proposed will infringe upon or violate any patent, copyright, trade secret, or other proprietary right of any third party. In the event of a claim by any third party against the State, the State shall promptly notify the proposer, and the proposer shall defend the claim. The defense will be at the proposer’s expense.

9. COST OF PREPARING PROPOSALS:

9.1. All costs incurred for preparing the proposal and for other procurement related activities are solely the proposer’s responsibility. The State of Wyoming will not provide reimbursement of these costs.

10. RISKS AND LIABILITIES:

10.1. By submitting a proposal, a proposer assumes any and all risks and liability associated with information in the proposal and its release.

11. AMENDMENTS:

11.1. The State reserves the right to amend this Request for Proposal before the proposal submission date. Amendments shall be uploaded to the Public Purchase online bidding system.

It is the proposer’s responsibility to check the Public Purchase online bidding system for amendments.

12. PROPERTY DAMAGE AND LIABILITY INSURANCE:

12.1. The proposer may be required to furnish proof of property damage liability insurance in the amount deemed necessary by the Agency for this project, if applicable.

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12.2. Questions regarding required insurance coverage and limits for this project should be submitted in writing, in accordance with instructions outlined in the special provisions.

13. MISREPRESENTATION OF INFORMATION:

13.1. Misrepresentation of a proposer’s status, experience, or capability in the proposal may result in disqualification of that proposer from the selection process. Discovery of litigation or investigations in a similar area of endeavor may, at the discretion of the Agency and after consultation with Procurement, preclude the proposer from the selection process.

14. DISPOSITION OF PROPOSALS:

14.1. All material submitted becomes property of the State of Wyoming, which is under no obligation to return any of the material submitted.

15. LEGAL CONSIDERATIONS:

15.1. This Request for Proposal is issued under Wyoming Statute §9-2-3204.

16. PROPOSER RELATIONS WITH STATE:

16.1. The proposer and its staff will have an ongoing relationship with the State that is based on trust, confidentiality, objectivity and integrity. The proposer will operate at all times in the State’s best interests and in a straightforward, trustworthy and professional manner. The proposer shall:

16.1.1. Work cooperatively with the State’s staff and business partners whenever required.

16.1.2. Work cooperatively with the staff of other proposers whenever required.

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SECTION 4: KEY DATES

Event Description Date Time (Mountain Time)

RFP Release Date May 22, 2025 N/A

Closing Date for Questions June 9, 2025 2:00 P.M.

Response to Questions Returned June 11, 2025 2:00 P.M.

RFP Submission Due Date June 23, 2025 2:00:00 P.M.

Tentative Award Date July 2025 N/A

Tentative Work Begins Date July 2025 N/A

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SECTION 5: ADMINISTRATIVE BACKGROUND

1. INTRODUCTION AND BACKGROUND:

1.1. Looking to retain a licensed pharmacy to provide medications for the Wyoming Retirement

Center, 890 US Hwy 20 South, Basin, Wyoming 82410 and its community members on a facility payer status or private or third-party payer status.

2. PURPOSE AND INTENT:

2.1. The purpose of this Request for Proposal (RFP) is to solicit competitive proposals from proposers who can offer pharmaceutical services to meet the Agency’s needs and expectations, as described within this RFP.

3. STAKEHOLDERS:

3.1. Stakeholders are the community members residing at Wyoming Retirement Center. A nursing home located in Basin, Wyoming 82410.

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SECTION 6: REQUIREMENTS/SPECIFICATIONS

1. SCOPE OF PROJECT:

Looking to retain a licensed pharmacy to provide medications for the Wyoming Retirement Center, 890

US Hwy 20 South, Basin, Wyoming 82410 and its community members on a facility-payer status or private or third-party payer status.

2. GENERAL REQUIREMENTS:

The proposer and the State covenant and agree that this proposal or subsequent Contract may, with the mutual approval of the proposer and the State, be extended under the same terms and conditions of this proposal or Contract for a period of two (2) years, and said option to extend this proposal or Contract for an additional two year period shall be in effect thereafter for a total contract period not to exceed six (6) years total.

The details of the consultation services will include, but are not limited to, the following:

Maintain a license to practice as a retail pharmacy in the State of Wyoming.

Provide professional pharmaceutical services for the dispensing of medications to the facility for residents on a facility-payer status and private or third-party payer status. This will include billing any supplemental prescription insurance coverage that the resident may have.

Provide Brand Name Prescription Medications at Average Wholesale Price minus the contractually agreed to percentage discount.

Provide Generic Prescription Medications at Average Wholesale Price minus the contractually agreed to percentage discount.

Provide all Over-The-Counter medications as ordered and requested by the facility according to an agreed upon method and authorization for request of medications at the following rate:

Facility Stock and Over-The-Counter (OTC) Medications

Formulary (OTC)-Average Wholesale Price minus the contractually agreed to percentage discount.

Non-Formulary (OTC)-Average Wholesale Price minus the contractually agreed to percentage discount.

Establish an approved procedure for ordering and delivering within one working day of medications prescribed by a physician for a facility resident(s).

PointClickCare (PCC) will be utilized to accomplish all of the following;

Establish an approved procedure for return of unutilized medications to the pharmacy for facility credit.

Provide routine medications in bulk packaging to be delivered at least twice per month in a large shipment for each resident whose written physician’s orders are currently on file.

New medication orders and changed medication orders will be delivered daily during the weekdays and on weekends when determined and mutually agreed to be of an urgent nature.

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New orders and changed orders will be delivered in sufficient quantities to match the next scheduled cycle-fill date.

Submit monthly individual invoicing for resident medications plus a total bill to facility for medication dispensed per contract. Provide an explanation of billing procedures and include a sample.

Report to the facility administration any irregularities found with reconciliation of records or utilization of resident facility-payer medications.

Delivery to the facility requested over-the-counter medications in mutually agreed upon bulk packaging size or type.

Devote a sufficient amount of time based upon the needs of the residents and facility to carry out the above listed responsibilities.

EVALUATION CRITERIA

Proposals will be evaluated and decisions made based on the following criteria and relative weights.

Criteria Points

1. Cost 40

2. Delivery Timeliness 20

3. Experience utilizing PointClickCare (PCC) 10

4. Returned medication credit provision 10

5. Experience with long term care and geriatric pharmaceutical care 10

6. Suitability of medication packaging system 5

7. Quality of monthly invoicing of each resident’s medication 5

TOTAL POSSIBLE POINTS 100

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SECTION 7: PROPOSAL SUBMISSION REQUIREMENTS

1. PRE-PROPOSAL CONFERENCE:

1.1. A pre-proposal conference will not be held in connection with this RFP.

2. TECHNICAL PROPOSAL, FORMAT AND CONTENTS:

2.1. Proposals should be submitted in two major sections: the Technical Proposal and the Cost

Proposal. Omission of this section or any item within this section may result in the proposal being eliminated. The proposer should, at a minimum, address the following points:

2.1.1. Executive Summary: The executive summary will condense and highlight the contents of the technical proposal in such a way as to provide the State with a broad understanding of the proposer’s qualifications and approach to meeting the requirements of the RFP.

2.1.2. Proposer’s Background and Experience: The proposer should include a company summary including the company history, location, office location(s), company size, financial statements (if applicable), and the statement of technical areas of expertise. The proposer should be able to substantiate to the satisfaction of the Agency that the proposer has sufficient resources to complete the project successfully within the time requirements.

2.1.3. References: Corporate references are required from at least three (3) prior clients. In addition, two (2) references are required for each of the staff members being proposed for the project.

Whenever possible, an alternative point of contact for each reference should be listed with a phone number and email address. Each reference should depict relevant experience that can be brought to bear during the term of this RFP. In order to ensure current expertise, all work for client references provided should have been completed no more than three years prior to the release date of this RFP.

2.1.3.1. References may be verified during the proposal evaluation by telephone calls made by members of the Evaluation Committee or through e-mail or the United States Postal

Service.

2.1.3.2. If contact with the referenced contact person or an alternative that has knowledge of the proposer is not made after reasonable attempts during the designated evaluation period, the reference will be classified as unsatisfactory. All attempts to contact a referenced client will be documented, including the date and time of the attempt.

2.1.3.3. The Agency reserves the right to contact other State of Wyoming agencies regarding engagements they may have had with the proposer’s company in the past, in addition to the references provided in the proposal.

2.1.4. Single Point of Contact: The proposer should identify a single point of contact for all contract management activities. The proposer’s Project Manager’s name and resume should be submitted with the proposal. The successful proposer should not change the Project Manager without written Agency approval.

2.1.5. Staffing and Project Organization: An organization chart should be included with all proposed personnel, including the supervisor level, functional responsibilities, key personnel, and other staff members who will be involved in the project.

3. COST PROPOSAL FORMAT AND CONTENT:

3.1. Cost Proposal Price Sheets: Each applicable proposer should upload the Technical Proposal and the Cost Proposal Sheets as separate documents, and identify them as such, using the Public

RFP 0256-K, Page 15 of 19

Purchase online bidding system. The price to be entered on this page is the total fixed price. In case of error in the extension of prices in the proposal, unit prices will govern. Cost breakdowns are not included on this page. The proposer should ensure all signatures and identifying numbers are properly affixed to this page in order for the Cost Proposal to be accepted.

4. ORAL PRESENTATIONS / INTERVIEWS:

4.1. Oral Presentations will not be held in connection with this RFP.

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SECTION 8: EVALUATION METHODOLOGY

1. OVERVIEW:

1.1. The Agency will conduct a comprehensive, fair, objective and impartial evaluation of proposals received in response to this Request for Proposal. Proposals will be evaluated independently by the evaluation committee members. The evaluation committee shall be made up of members representing the project subject expertise. The evaluation committee will review and score all proposals independently and consolidate the scores in order to determine the award.

2. COMPLIANCE WITH MANDATORY REQUIREMENTS:

2.1. To be considered responsive, a submitted proposal should meet the minimum requirements defined in this RFP. The minimum requirements are intended to ensure that evaluation of the Technical

Proposal can proceed and that the Contractor agrees to perform all responsibilities within the RFP.

3. COST ANALYSIS:

3.1 The State of Wyoming reserves the right to conduct a cost analysis of the Proposer’s budget proposal. The analysis will include a review of the associated costs based on the technical content of their submission. The firm which best meets the conditions of each of the individual criterion will be awarded the highest (not necessarily maximum) points for that specific criterion. The balance of the proposing contractors will be rated based on their evaluated points.

4. PAYMENT TERMS (IF APPLICABLE):

4.1 The State will negotiate payment terms based upon a schedule to be determined by the proposer and the State. Paying invoices will be based upon the proposer successfully completing the deliverables within the stated deadlines, and upon the Agency’s written acceptance of the deliverables or services.

5. EVALUATION POINT SUMMARY:

Proposals will be evaluated and decisions made based on the following criteria and relative weights.

Evaluation Criteria

Points

1. Cost 40

2. Delivery Timeliness 20

3. Experience utilizing PointClickCare (PCC) 10

4. Returned medication credit provision 10

5. Experience with long term care and geriatric pharmaceutical care 10

6. Suitability of medication packaging system 5

7. Quality of monthly invoicing of each resident’s medication 5

TOTAL POSSIBLE POINTS 100

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6. FINAL RANKING OF PROPOSALS:

The State of Wyoming will be the sole authority of evaluating proposals. The firm that best meets the conditions of each of the criterion will be awarded the highest (not necessarily maximum) points for that criterion. The balance of the proposals will be rated based on their evaluated points. After each criterion is evaluated, the proposer with the highest number of points will be notified. The State of

Wyoming reserves the right to reject any or all proposals, to waive any informality of technical defect in the proposals, or to award the contract in whole or in part, if deemed in the best interest of the State to do so.

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SECTION 9: PROPOSAL PRICE SHEET AND SIGNATURE PAGE

The undersigned agrees to provide Pharmaceutical Services to the Wyoming Department of Health, Wyoming Retirement Center in accordance with the Request for Proposal, General Provisions, Special

Provisions and Proposal Price Sheet for Request for Proposal Number 0256-K.

PHARMACEUTICAL SERVICES

1. Brand Name Prescription Medication $________________________________

2. Generic Prescription Medication $_______________________________

3. Formulary (OTC) $________________________________

4. Non-Formulary (OTC) $________________________________

5. Other Fees (please describe) $________________________________

1. BY SUBMISSION OF A PROPOSAL, THE PROPOSER CERTIFIES:

1.1. Prices in this proposal have been arrived at independently, without consultation, communication or agreement for the purpose of restricting competition.

1.2. The Proposer has not and will not attempt to induce any other person or firm to submit a proposal for the purpose of restricting competition.

1.3. The person signing this proposal certifies they are authorized to represent the company and are legally responsible for the price and supporting documentation provided as a result of this advertisement.

1.4. Proposer will comply with all applicable state and federal regulations, policies, guidelines and requirements.

Prices in this proposal have not been knowingly disclosed by the proposer nor will they be disclosed prior to award.

2. GENERAL INFORMATION:

Proposer Name: Phone:

Email Address:

Mailing Address:

City: State: Zip:

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Employer Identification Number (EIN):

3. OWNERSHIP AND CONTROL:

Proposer’s Legal Structure

Sole Proprietorship General Partnership Corporation

Limited Partnership Other

The proposer shall provide to the Agency a certificate of good standing from the Wyoming Secretary of

State or other proof that proposer is authorized to conduct business in the State of Wyoming before performing work under this Contract. The proposer shall ensure all annual filing and corporate taxes due and owing to the Wyoming Secretary of State’s office are up-to-date before signing the contract. Proposers may contact the Wyoming Secretary of State’s office, Corporate Division at (307) 777-7311 for assistance.

4. VENDOR VERIFICATION

I certify under penalty of perjury, that I am a responsible official (as identified above) for the business entity described above as the proposer, that I have personally examined and am familiar with the information submitted in this disclosure and all attachments, and that the information is true, accurate and complete. I may be charged significant penalties for submitting false information, including criminal sanctions, which can lead to fines and/or imprisonment.

Signature Date

Name Title