36C24922Q0555_1.docx

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16. ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

UEI:

EFT:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

486-23-1-3980-0001 36C24922Q0555 08-04-2022 Olonzo Haynes 615-225-6959 09-06-2022 10:00

CDT

Department of Veterans Affairs Network Contracting Office 9 (90C) ATTN: Olonzo Haynes 1639 Medical Center Parkway, Suite 400 Murfreesboro TN 37129 X X 524292 $35 Million N/A X Department of Veterans Affairs Veterans Integrated Service Network 9 VISN 9 Pharmacist Exc.-Mark A. Slagle 1801 West End Ave, Suite 600 Nashville TN 37203 90C Network Contracting Office (NCO) 9 Department of Veterans Affairs Contract Specialist: Olonzo Haynes 1639 Medical Center Parkway Suite 400 Murfreesboro TN 37129

90C FSC e-Invoicing Payment http://www.fsc.va.gov/fsc/einvoice.asp Invoice Setup Information 1-877-489-6135 Invoice must be submitted electronically

Setup 1-877-489-6135 See CONTINUATION Page The Veterans Integrated Service Network (VISN) 9 has a requirement for Pharmacy Benefits Management (PBM) Services in accordance with the Statement of Work (SOW), as provided herein. This requirement is being procured under the authority of the Federal Acquisition Regulation (FAR) Part 13.106-2 (b)(3) & 13.5. A best value determination shall be made based on quoter's price and other factors (See E.1 Addendum 52.212-1 & E.6 Addendum 52.212-2). This RFQ is 100% SDVOSB set-aside under the authority of 38 USC 8153.

This RFQ will result in a Five (5) year base and One (1) option consisting of a Five (5) year ordering period, for a total period of performance of Ten (10) years from award.

The Wage Determination will be based on the specified locality of the awardee.

All SDVOSB/VOSB must have a current VETS 4212 on file with DOL registered in SAM, and must be CVE verified in VetBiz when quote is submitted, and at time of award.

$0.00 See CONTINUATION Page 486-3630160-3980-822400-2580 010065400 X X X Dewana M. Raynor Contracting Officer Table of Contents

Pharmacy Benefits Management (PBM) Services

A.2 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C249 Dewana M. Raynor Department of Veterans Affairs Network Contracting Office 9 (90C) ATTN: Olonzo Haynes 1639 Medical Center Parkway, Suite 400 Murfreesboro TN 37129

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

3. INVOICES: Invoices shall be submitted in arrears:

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

FSC e-Invoicing Payment http://www.fsc.va.gov/fsc/einvoice.asp ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

Page 1 of

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 PRICE/COST SCHEDULE

ITEM INFORMATION

Five (5) Year Base Contract Period: Base POP Begin: 10-01-2022 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology Emergency filling, dispensing and counseling on emergency prescriptions and controlled substances in quantities up to a ten-day supply.

0001AA

Year 1 Dispensing Fee TVHS

POP Begin: 10-01-2022 POP End: 09-30-2023 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds

0001AB

Year 1 Per Prescription TVHS

POP Begin: 10-01-2022 POP End: 09-30-2023 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology Cost of Prescriptions - Generic AWP less 59% discount Cost of Prescriptions - Brand Name AWP less 15% discount

0001AC

Year 1 Dispensing Fee Louisville

POP Begin: 10-01-2022 POP End: 09-30-2023

0001AD

Year 1 Prescription Louisville

POP Begin: 10-01-2022 POP End: 09-30-2023 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001AE

Year 1 Dispensing Fee Lexington

POP Begin: 10-01-2022 POP End: 09-30-2023

0001AF

Year 1 Per Prescription Lexington

POP Begin: 10-01-2022 POP End: 09-30-2023 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001AG

Year 1 Dispensing Fee Memphis

POP Begin: 10-01-2022 POP End: 09-30-2023

0001AH

Year 1 Per Prescription Memphis

POP Begin: 10-01-2022 POP End: 09-30-2023 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001AI

Year 1 Dispensing Fee Mountain Homes

POP Begin: 10-01-2022 POP End: 09-30-2023

0001AJ

Year 1 Per Prescription Mountain Homes

POP Begin: 10-01-2022 POP End: 09-30-2023 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001BA

Year 2 Dispensing Fee TVHS

POP Begin: 10-01-2023 POP End: 09-30-2024

0001BB

Year 2 Per Prescription TVHS

POP Begin: 10-01-2023 POP End: 09-30-2024 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001BC

Year 2 Dispensing Fee Louisville

POP Begin: 10-01-2023 POP End: 09-30-2024

0001BD

Year 2 Prescription Louisville

POP Begin: 10-01-2023 POP End: 09-30-2024 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001BE

Year 3 Dispensing Fee Lexington

POP Begin: 10-01-2023 POP End: 09-30-2024

0001BF

Year 2 Per Prescription Lexington

POP Begin: 10-01-2023 POP End: 09-30-2024 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001BG

Year 2 Dispensing Fee Memphis

POP Begin: 10-01-2023 POP End: 09-30-2024

0001BH

Year 2 Per Prescription Memphis

POP Begin: 10-01-2023 POP End: 09-30-2024 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001BI

Year 2 Dispensing Fee Mountain Homes

POP Begin: 10-01-2023 POP End: 09-30-2024

0001BJ

Year 2 Per Prescription Mountain Homes

POP Begin: 10-01-2023 POP End: 09-30-2024 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001CA

Year 3 Dispensing Fee TVHS

POP Begin: 10-01-2024 POP End: 09-30-2025

0001CB

Year 3 Per Prescription TVHS

POP Begin: 10-01-2024 POP End: 09-30-2025 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001CC

Year 3 Dispensing Fee Louisville

POP Begin: 10-01-2024 POP End: 09-30-2025

0001CD

Year 3 Prescription Louisville

POP Begin: 10-01-2024 POP End: 09-30-2025 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001CE

Year 3 Dispensing Fee Lexington

POP Begin: 10-01-2024 POP End: 09-30-2025

0001CF

Year 3 Per Prescription Lexington

POP Begin: 10-01-2024 POP End: 09-30-2025 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001CG

Year 3 Dispensing Fee Memphis

POP Begin: 10-01-2024 POP End: 09-30-2025

0001CH

Year 3 Per Prescription Memphis

POP Begin: 10-01-2024 POP End: 09-30-2025 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001CI

Year 3 Dispensing Fee Mountain Homes

POP Begin: 10-01-2024 POP End: 09-30-2025

0001CJ

Year 3 Per Prescription Mountain Homes

POP Begin: 10-01-2024 POP End: 09-30-2025 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001DA

Year 4 Dispensing Fee TVHS

POP Begin: 10-01-2025 POP End: 09-30-2026

0001DB

Year 4 Per Prescription TVHS

POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001DC

Year 4 Dispensing Fee Louisville

POP Begin: 10-01-2025 POP End: 09-30-2026

0001DD

Year 4 Prescription Louisville

POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001DE

Year 4 Dispensing Fee Lexington

POP Begin: 10-01-2025 POP End: 09-30-2026

0001DF

Year 4 Per Prescription Lexington

POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001DG

Year 4 Dispensing Fee Memphis

POP Begin: 10-01-2025 POP End: 09-30-2026

0001DH

Year 4 Per Prescription Memphis

POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001DI

Year 4 Dispensing Fee Mountain Homes

POP Begin: 10-01-2025 POP End: 09-30-2026

0001DJ

Year 4 Per Prescription Mountain Homes

POP Begin: 10-01-2025 POP End: 09-30-2026 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001EA

Year 5 Dispensing Fee TVHS

POP Begin: 10-01-2026 POP End: 09-30-2027

0001EB

Year 5 Per Prescription TVHS

POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001EC

Year 5 Dispensing Fee Louisville

POP Begin: 10-01-2026 POP End: 09-30-2027

0001ED

Year 5 Prescription Louisville

POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001EE

Year 5 Dispensing Fee Lexington

POP Begin: 10-01-2026 POP End: 09-30-2027

0001EF

Year 5 Per Prescription Lexington

POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001EG

Year 5 Dispensing Fee Memphis

POP Begin: 10-01-2026 POP End: 09-30-2027

0001EH

Year 5 Per Prescription Memphis

POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

0001EI

Year 5 Dispensing Fee Mountain Homes

POP Begin: 10-01-2026 POP End: 09-30-2027

0001EJ

Year 5 Per Prescription Mountain Homes

POP Begin: 10-01-2026 POP End: 09-30-2027 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

Option One (1) Five (5) Year Ordering Periods Contract Period: Option 1 POP Begin: 10-01-2027 POP End: 09-30-2032 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds

Emergency filling, dispensing and counseling on emergency prescriptions and controlled substances in quantities up to a ten-day supply. Option One (1) Five Ordering Period

1001AA

Ordering Period 1 Dispensing Fee TVHS

POP Begin: 10-01-2027 POP End: 09-30-2028

1001AB

Ordering Period 1 Per Prescription TVHS

POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001AC

Ordering Period 1 Dispensing Fee Louisville

POP Begin: 10-01-2027 POP End: 09-30-2028

1001AD

Ordering Period 1 Prescription Louisville

POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001AE

Ordering Period 1 Dispensing Fee Lexington

POP Begin: 10-01-2027 POP End: 09-30-2028

1001AF

Ordering Period 1 Per Prescription Lexington

POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001AG

Ordering Period 1 Dispensing Fee Memphis

POP Begin: 10-01-2027 POP End: 09-30-2028

1001AH

Ordering Period 1 Per Prescription Memphis

POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001AI

Ordering Period 1 Dispensing Fee Mountain Homes

POP Begin: 10-01-2027 POP End: 09-30-2028

1001AJ

Ordering Period 1 Per Prescription Mountain Homes

POP Begin: 10-01-2027 POP End: 09-30-2028 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001BA

Ordering Period 2 Dispensing Fee TVHS

POP Begin: 10-01-2028 POP End: 09-30-2029

1001BB

Ordering Period 2 Per Prescription TVHS

POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001BC

Ordering Period 2 Dispensing Fee Louisville

POP Begin: 10-01-2028 POP End: 09-30-2029

1001BD

Ordering Period 2 Prescription Louisville

POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001BE

Ordering Period 3 Dispensing Fee Lexington

POP Begin: 10-01-2028 POP End: 09-30-2029

1001BF

Ordering Period 2 Per Prescription Lexington

POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001BG

Ordering Period 2 Dispensing Fee Memphis

POP Begin: 10-01-2028 POP End: 09-30-2029

1001BH

Ordering Period 2 Per Prescription Memphis

POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001BI

Ordering Period 2 Dispensing Fee Mountain Homes

POP Begin: 10-01-2028 POP End: 09-30-2029

1001BJ

Ordering Period 2 Per Prescription Mountain Homes

POP Begin: 10-01-2028 POP End: 09-30-2029 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001CA

Ordering Period 3 Dispensing Fee TVHS

POP Begin: 10-01-2029 POP End: 09-30-2030

1001CB

Ordering Period 3 Per Prescription TVHS

POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001CC

Ordering Period 3 Dispensing Fee Louisville

POP Begin: 10-01-2029 POP End: 09-30-2030

1001CD

Ordering Period 3 Prescription Louisville

POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001CE

Ordering Period 3 Dispensing Fee Lexington

POP Begin: 10-01-2029 POP End: 09-30-2030

1001CF

Ordering Period 3 Per Prescription Lexington

POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001CG

Ordering Period 3 Dispensing Fee Memphis

POP Begin: 10-01-2029 POP End: 09-30-2030

1001CH

Ordering Period 3 Per Prescription Memphis

POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001CI

Ordering Period 3 Dispensing Fee Mountain Homes

POP Begin: 10-01-2029 POP End: 09-30-2030

1001CJ

Ordering Period 3 Per Prescription Mountain Homes

POP Begin: 10-01-2029 POP End: 09-30-2030 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001DA

Ordering Period 4 Dispensing Fee TVHS

POP Begin: 10-01-2030 POP End: 09-30-2031

1001DB

Ordering Period 4 Per Prescription TVHS

POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001DC

Ordering Period 4 Dispensing Fee Louisville

POP Begin: 10-01-2030 POP End: 09-30-2031

1001DD

Ordering Period 4 Prescription Louisville

POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001DE

Ordering Period 4 Dispensing Fee Lexington

POP Begin: 10-01-2030 POP End: 09-30-2031

1001DF

Ordering Period 4 Per Prescription Lexington

POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001DG

Ordering Period 4 Dispensing Fee Memphis

POP Begin: 10-01-2030 POP End: 09-30-2031

1001DH

Ordering Period 4 Per Prescription Memphis

POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001DI

Ordering Period 4 Dispensing Fee Mountain Homes

POP Begin: 10-01-2030 POP End: 09-30-2031

1001DJ

Ordering Period 4 Per Prescription Mountain Homes

POP Begin: 10-01-2030 POP End: 09-30-2031 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001EA

Ordering Period 5 Dispensing Fee TVHS

POP Begin: 10-01-2031 POP End: 09-30-2032

1001EB

Ordering Period 5 Per Prescription TVHS

POP Begin: 10-01-2031 POP End: 09-30-2032 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001EC

Ordering Period 5 Dispensing Fee Louisville

POP Begin: 10-01-2031 POP End: 09-30-2032

1001ED

Ordering Period 5 Prescription Louisville

POP Begin: 10-01-2031 POP End: 09-30-2032 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001EE

Ordering Period 5 Dispensing Fee Lexington

POP Begin: 10-01-2031 POP End: 09-30-2032

1001EF

Ordering Period 5 Per Prescription Lexington

POP Begin: 10-01-2031 POP End: 09-30-2032 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001EG

Ordering Period 5 Dispensing Fee Memphis

POP Begin: 10-01-2031 POP End: 09-30-2032

1001EH

Ordering Period 5 Per Prescription Memphis

POP Begin: 10-01-2031 POP End: 09-30-2032 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

1001EI

Ordering Period 5 Dispensing Fee Mountain Homes

POP Begin: 10-01-2031 POP End: 09-30-2032

1001EJ

Ordering Period 5 Per Prescription Mountain Homes

POP Begin: 10-01-2031 POP End: 09-30-2032 PRINCIPAL NAICS CODE: 524292 - Third Party Administration of Insurance and Pension Funds PRODUCT/SERVICE CODE: Q517 - Medical - Pharmacology

B.2 STATEMENT OF WORK

PHARMACY BENEFITS MANAGEMENT (PBM) SERVICES

VISN-9

1. PHARMACEUTICAL SERVICES:

a. The Contractor is to provide Pharmacy Benefits Management at contractor’s facility or subcontracted facility to include filling, dispensing and counseling on emergency prescriptions and controlled substances in quantities up to a ten-day supply for prescriptions written by the care providers employed at the designated VA Clinics and Community Based Outpatient Clinics (CBOCs) in the region served by the Department of Veterans Affairs Veterans Integrated Service Network (VISN) 9. (Provider lists to be provided to awarded contractor.) Contractor shall provide dispensing fees with discounted rates offered on both “brand name” and “generic” prescription as outlined by the American Druggist Blue Book Average Wholesale Price (AWP).

b. At a minimum, the contractor will have a facility located within a thirty minute drive of each VISN 9 CBOC location (see attachment list of CBOC addresses). These facilities shall be handicapped accessible, have handicapped parking spaces available and ample seating for patients waiting on their prescriptions. Under the Department of Veterans CARES initiative, new CBOCs are planned for activation in VISN 9. Additional areas will be added to this contract by mutual agreement as services are needed for new CBOCs in the VISN 9 service area.

c. Offeror shall provide all prescribed therapeutic agents to patients at wholesale pricing per price list minus discount listed in Price Schedule. Any dispensing fees must be included in pricing or listed by the Offeror as a separate line item.

d. The total cost charges to the VA shall be the same or lower than that charged to their best customer and in no case, more than charged to the general public. The contractor must provide a price list to the Contracting Officer showing pricing of the pharmaceuticals. Because prices change constantly, the contractor must submit the revised price list to the Contracting Officer on a quarterly basis.

e. Prescriptions filled under this contract shall be, to the extent permitted by law, the least expensive drug product that the contract pharmacy has in stock. Generic drugs shall be dispensed whenever possible. Generic drugs will be dispensed if, in the professional judgment of the pharmacist, the available substitute product is safe and effective to the greatest extent possible, contains the same chemical ingredients in the same strength and dosage of the brand name. All generic products used shall be in compliance with Federal and State requirements. Brand name products will be dispensed only if there is no therapeutic equivalent product listed as (AB) equivalent. The generic name must be indicated on drug label for all medications.

f. VA Beneficiaries will pick up their own prescriptions at the dispensing pharmacy. No prescriptions are to be mailed. No prescriptions are to be delivered.

g. After start-up of the contract notification of provider information may occur on either the day the VA provider fills in at the CBOC or prior to CBOC duty as time allows. The contractor shall accept a call from the Contracting Officer, OR the Contracting Officer’s Representative advising him/her of all new VA provider’s state license number and federal and/or state drug license number.

h. The services to be performed by the contractor will be performed in accordance with VA policies and procedures and the regulations of the medical staff by-laws of the VA facility and in accordance with all applicable federal, stated, city and local laws.

i. If a new CBOC is to be opened, the Contracting Officer will notify the Contractor. Additional locations and pharmacies will be added by formal modification to the task order contract.

2. RESOURCES: Prescriptions shall be filled and dispensed for medications on the VISN 9 CBOC Formulary. Contractor shall not provide medications not on this listing without prior approval from the Contracting Officer’s Technical Representative. Any revisions to the VA (CBOC) formulary will be provided by Contracting Officer’s Technical Representative to the Contracting Officer to be incorporated into the contract by modification processed by the VA Contracting Officer, including any pre-approvals as stated herein. The VISN 9 CBOC formulary will be reviewed periodically by the VA Formulary Committee, and any additions or deletions will be communicated via e-mail to the contractor, who will make these changes in the contractor’s systems within five (5) business days.

3. QUANTITIES: The contractor shall fill only new prescriptions for emergent or controlled substance medication up to a ten-day supply with no refills. Exceptions to the ten-day supply limit apply to antibiotics where the entire course of therapy may be dispensed, up to a 14 day supply. The VA will accomplish refills of prescriptions through the ‘pharmacy mail out’ program.

4. MEDICATION ORDER REVIEW

Pharmacist will collect, synthesize interpret patient, prescription and disease data. Check for actual and potential drug-related problems including:

· Therapeutic duplication

· Drug-disease contraindications

· Drug-drug interactions (including interactions with over-the-counter drugs)

· Incorrect drug dosage

· Inappropriate duration of treatment

· Drug-allergy interactions

· Clinical abuse/misuse

5. PATIENT-FOCUSED CARE

a. All patients will be offered counseling by a pharmacist consistent with Omnibus Budget Reconciliation Act (OBRA) 1990 requirement to ensure appropriate use and optimal outcomes form drug therapy. Counseling includes the following information at minimum:

· Name, description and use of the medications.

· Dose, dosage form and route

· Special directions and precautions

· Common side effects and action required if they occur

· Techniques for self-monitoring drug therapy

· Action to be taken if a dose is missed

· Proper storage

· What the patient can expect from the medication

b. A pharmacist will be available to answer any drug-related questions that a patient may have after the prescription is filled. This may be in the form of written and/or verbal information.

6. FORMULARY MANAGEMENT

a. Strict adherence to the CBOC Formulary is expected to ensure cost-effective and safe medications are dispensed. Prescription services will conform to the attached CBOC Formulary (Reference Attachment).

b. Medical supplies, injectables. and prosthetic items are not included in this contract except for insulin vials and syringes. Medical supplies, injectables, and prosthetic items will be provided (directly to the patient) by the appropriate VA Pharmacy Service.

c. Any other exceptions to the prescription formulary requirements of the contract must be pre-authorized by the respective COR at the responsible VA facility. Decisions of the VA STATION COR are final. VA CORs may retroactively approve exceptions, but the decision to retroactively consider, review or approve retroactive request for exceptions is solely at the discretion of the VA.

7. QUALITY CONTROL/IMPROVEMENT

a. All medication errors and medication related incidents will be recorded and reported to the COR at the applicable VA Medical Center every month.

b. Adverse drug event reporting: All medication errors, adverse drug reactions or allergy reactions related to medications dispensed under this contract shall be reported to the COR of the responsible VA Medical Center.

c. Customer complaints/suggestion/compliments will be recorded and forwarded to the COR or his/her designee at the applicable VA Medical Center every month (or more frequently if a significant problem occurs).

8. OPERATIONAL REQUIREMENTS

a. Prescribers will be responsible for providing all necessary dispensing information. This includes name, address, date of birth, social security number and telephone number of the patient and the name, address, DEA and telephone numbers of the physician. Prescribers will also be requested to list the indication for medication prescribed in the instructions for use on each prescription.

b. The Contractor shall designate a program manager (contractor representative) under this contract delivery order and shall provide his/her name, title, address, phone number, fax number, and e-mail address to the Contracting Officer and each COR. The program manager shall work closely with the COR in regard to all services covered by the contract delivery order and/or any issues arising under the contract delivery order.

9. QUALIFICATIONS

a. Pharmaceutical care provided to beneficiaries under this contract shall meet all standards applicable to Medicaid recipients in the State where the services are provided.

b. Personnel assigned by the contractor to perform the services covered by this contract shall be licensed in good standing in a State, Territory or Commonwealth of the United States or the District of Columbia. The qualifications of such personnel shall also be subject to review by the VA Chief of Staff and approval by the VA Facility Director. Offerors are required to obtain all Federal, State, and/or local licenses and certifications(s) applicable to the provision of Pharmaceuticals and Pharmacy Services. License shall be current and in good standing and a copy forwarded to the Department of Veterans Affairs Contracting Officer at the time of award.

c. Contractor shall fill prescription within one-hour period from presentation of the prescription by the patient.

d. The contractor agrees that all information concerning VA beneficiaries shall be kept confidential and shall not be disclosed to any person, except as authorized in writing and according to all applicable laws.

e. Staff Competency: The contractor shall have an employee competency assessment and evaluation system in place for pharmacists filling prescriptions for Veterans.

f. The contractor shall continuously meet or exceed Joint Commission Medication use standards related to procurement, preparation, dispensation, control and security, recall, and patient education. Additional information related to these standards can be accessed through the Joint Commission website at www.jointcommission.org.

10. PACKAGING AND MARKINGS: All prescriptions MUST have appropriate auxiliary labels attached to the containers. Consideration must be given to a patient’s ability to open “childproof” containers. Generic name must be indicated on drug label for all medications. Beyond use dating and lot numbers should be present on all dispensed containers.

11. MEDICAL RECORDS: Representatives of the VA are authorized to visit the premises of service contractors during business hours for purposes of evaluation and auditing, which may include inspection of prescription records.

12. SPECIAL CONTRACT REQUIREMENTS

a. WORK HOURS:

i. The services covered by this contract shall be furnished by the contractor as defined herein. The contractor will not be required, except in case of emergency, to furnish such services during off-duty hours as described below.

ii. The following terms have the following meanings:

Work hours: At minimum, the contractor's hours of operation will be Monday through Friday, 8:00 a.m. - 4:30 P.M (local time), excluding all National Holidays or any other day specifically declared by the President of the United States to be a national holiday.

National Holidays: The ten (10) holidays observed by the Federal Government are:

· New Year’s Day

· Birthday of Martin Luther King, Jr.

· Washington' Birthday

· Memorial Day

· Juneteenth

· Independence Day

· Labor Day

· Columbus Day

· Veterans Day

· Thanksgiving Day

· Christmas Day

b. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) The services to be provided under this task order contract are subject to protection under regulations issued by the Department of Health and Human Services, as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR Parts 160 and 164, Subparts A and E, the Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”), and 45 CFR Parts 160 and 164, Subparts A and C, The Security Standard (“Security Rule”). A Business Associate Agreement (BAA) must complete and signed in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The completed and signed BAA must be returned to the Contracting Officer within two (2) days after receipt of award.

c. HHS/OIG To ensure that the individuals providing services under the contract have not engaged in fraud or abuse regarding Sections 1128 and 1128A of the Social Security Act regarding federal health care programs, the Contractor is required to check the Health and Human Services—Office of Inspector General (HHS/OIG), List of Excluded Individuals/Entities on the OIG Website (www.hhs.gov/oig) for each person providing services under this contract. Further the Contractor is required to certify in its proposal that all persons listed in the Contractor’s proposal have been compared against the OIG list and are NOT listed. During the performance of this contract the Contractor is prohibited from using any individual or business listed on the List of Excluded Individuals/Entities.

d. PRIVACY ACT/VA CONFIDENTIALITY STATUTES Any VA Contractor’s employees who are given access to VA records that are protected by the Privacy Act of 1974 (Title 5 U.S.C. Section 552a) or any other VA Confidentiality Statute, including Title 38 U.S.C. Sections 5701 (which protects the confidentiality of the names and addresses of VA beneficiaries and their dependents), 5705 (which protects the confidentiality of medical quality assurance records, and 7332 (which protects the confidentiality of drug, alcohol, sickle cell anemia and HIV records) shall be considered to be employees of the agency (VA) for all intents and purposes pertaining to the confidentiality requirements of these laws. Appropriate procedures must be instituted to safeguard all such information received in performance of this contract. No information will be disclosed to any Contractor/subcontractor employee except as necessary and appropriate on a need to know basis to carry out the provisions of this contract. Any Contractor/ subcontractor employee who makes an unauthorized disclosure or re-disclosure of protected information will be guilty of a misdemeanor and subject to a fine of up to $5,000 for a first offense. A second offense of any VA Confidentiality Statute will result in a fine of up to $20,000.

13. CONTRACTING OFFICER’S REPRESENTATIVES (CORs) The VISN-wide Contracting Officer’s Representative (COR) shall be responsible for the overall technical administration of this contract as outlined in the COR Delegation of Authority.

Pharmacy Staff shall be responsible for reviewing and certifying invoices to ensure they reflect accurately the work completed in accordance with the requirements of the task orders. Through invoices entered in IPPS, the Pharmacy Staff shall also verify that services billed were indeed rendered. COR shall furnish the Contracting Officer notice of any unsatisfactory areas. COR shall be responsible for the technical administration of the task orders as outlined in the COR Delegation of Authority.

14. INVOICES/BILLING

a. SUMMARY INVOICES: The contractor shall bill the individual VA facilities monthly for services rendered in their respective CBOCs. The VA will pay for services based on the rates established in the Schedule of Costs. Invoices shall include the contract number, the applicable station task order number, and the contractor’s tax identification number. Invoices WITH NO PATIENT-SPECIFIC DATA shall be submitted to Tungsten. Patient-specific data will be provided via encrypted e-mail directly to the VA facilities.

b. DETAILED INVOICES: Contract pharmacies shall maintain a secure electronic log of VA Prescriptions filled and have the patient sign next to each prescription number for each prescription received. This log shall be securely maintained at the contract pharmacy and be readily accessible for random VA audit. The VA will randomly audit all billings. The contractor must make prescription records available to the auditor in a timely manner at the location where dispensed if requested.

Invoices shall contain at a minimum the following information:

· Invoice number and date of invoice

· Patient’s Name

· Patient’s Social Security Number and date of birth

· Name of Provider and Provider ID

· Prescription Number and NABP number

· Date Rx written and date Rx dispensed

· Generic/Brand code

· Name, strength, quantity, days’ supply, and NDC number of medication dispensed

· Contractor’s charge (includes ingredient cost of medication, dispensing fee, administrative fee, and total amount due) The detailed invoice with patient/prescription-specific information shall be sent electronically, with VA-approved encryption to the respective station COR for review and certification:

Murfreesboro, TN 37129

Nashville, TN 37212

Lexington, KY 40502

Memphis, TN 38104

Louisville, KY 40206

Mountain Home, TN 37684

c. PAYMENT IN FULL: Payments by the VA shall constitute full payment. Neither the patient nor his/her insurance carrier(s) shall be billed by the Contractor for services and supplies provided under this contract.

The contractor/subcontractor must store, transport, or transmit VA sensitive information in an encrypted form, using VA-approved encryption tools that are, at a minimum, FIPS 140-2 validated. ALL mailings containing patient information SHALL be sent with the ability to be tracked; this can be by certified mail, priority mail with tracking, FedEx, DHL, or any other option that provides the Contractor with tracking capabilities.

Contract award will be made to the offer that best meets the requirements as stated in the solicitation and whose offer provides the most favorable discount from the AWP (average wholesale price) listed in the most current (latest) edition of the Pharmacy Fundamental Reference REDBOOK and REDBOOK updates or Medi-Span, and the most favorable dispensing fee. Contract award will also be to the offeror that has pharmacies within its network that are geographically accessible to the CBOC, both patient and handicapped accessible, and which have the most accessible day and evening hours.

END OF STATEMENT OF WORK

SECTION C - CONTRACT CLAUSES

C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (NOV 2021)

(a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights—

(1) Within a reasonable time after the defect was discovered or should have been discovered; and

(2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item.

(b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g., use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract.

(c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties.

(d) Disputes. This contract is subject to 41 U.S.C. chapter 71, Contract Disputes. Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at Federal Acquisition Regulation (FAR) 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract.

(e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference.

(f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence.

(g) Invoice.

(1) The Contractor shall submit an…