36C25718Q0458-003.docx

36C25718Q0458

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.

DUNS:

DUNS+4:

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. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

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

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C25718Q0458 03-15-2018

ROBERT KELLEY

210-694-6312 03-23-2018 Department of Veterans Affairs VISN17 Network Contracting Activity 7400 Merton Minter Blvd. (10N17/90C) San Antonio

TX

78229 X X 325412 1250 Employees X N/A X Department of Veterans Affairs VISN17 Network Contracting Activity 7400 Merton Minter Blvd. (10N17/90C) San Antonio

TX

78229-4401 Department of Veterans Affairs VISN17 Network Contracting Activity 7400 Merton Minter Blvd. (10N17/90C) San Antonio

TX

78229

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin

TX

78714-9971 See CONTINUATION Page See CONTINUATION Page X X

A.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes VAAR 852.219-10 VA Notice of Total Service- Disabled Veteran-Owned Small Business Set-Aside. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.

Table of Contents

SECTION B - CONTINUATION OF SF 1449 BLOCKS

36C25718Q0458

Page 1 of Page 1 of

A.2 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C671:

Department of Veterans Affairs VISN17 Network Contracting Activity 7400 Merton Minter Blvd. (10N17/90C) San Antonio TX 78229

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:

a. Quarterly []

b. Semi-Annually []

c. Other [] X Upon Delivery

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.

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

B.1 PRICE/COST SCHEDULE

ITEM INFORMATION

Contract Period: Base POP Begin: 04-01-2018 POP End: 03-31-2019

Contract Period: Option 1 POP Begin: 04-01-2019 POP End: 03-31-2020

Contract Period: Option 2 POP Begin: 04-01-2020 POP End: 03-31-2021

Contract Period: Option 3 POP Begin: 04-01-2021 POP End: 03-31-2022

Contract Period: Option 4 POP Begin: 04-01-2022 POP End: 03-31-2023

South Texas Veterans Health Care System: Bid Proposal Base Year: April 1, 2018 through March 31, 2019

Option Year 1: April 1, 2019 through March 31, 2020

Option Year II: April 1, 2020 through March 31, 2021

Option Year III: April 1, 2021 through March 31, 2022

Option Year IV: April 1, 2022 through March 31, 2023

Flu Vaccinations

Injectable Seasonal Influenza Vaccine (Trivalent) – Per Vaccination

$0.00 Fixed Fee

Injectable Seasonal Influenza Vaccine (Quadrivalent) – Per Vaccination

$0.00 Fixed Fee

Intranasal Seasonal Influenza Vaccine (FluMist) – Per Vaccination

$0.00 Fixed Fee

Intradermal Influenza Vaccine Trivalent (Short Needle) – Per Vaccination

$0.00 Fixed Fee

Intradermal Influenza Vaccine Quadrivalent (Short Needle) and Flublok – Per Vaccination

$0.00 Fixed Fee

Injectable Seasonal Influenza Vaccine High-Dose (Fluzone) – Per Vaccination

$0.00 Fixed Fee

Other Vaccinations $0.00 + $0.00 Administration Fee

SOUTH TEXAS VETERANS HEALTH CARE SYSTEM

Community Based Outpatient Clinic Emergent Prescription Services

1. INTRODUCTION AND SCOPE OF WORK:

a. Introduction: South Texas Veterans Health Care System (STVHCS) must provide Veteran patients served by Community Based Outpatient Clinics (CBOC’s) a way to have emergent prescriptions filled quickly near where they live to preclude the need to drive longer distances to Department of Veterans Affairs (VA) pharmacies. Once a Veteran patient’s emergent prescription need is met, subsequent refills can be provided by mail from a VA pharmacy.

(1) Background: A Veteran patient seen at a Community Based Outpatient Clinic (CBOC) without an onsite pharmacy may receive pharmacy services from a contracted Pharmacy Benefits Management (PBM) company. The PBM is expected to provide formulary management for a list of medications approved by VA Pharmacy and supply a retail pharmacy network that can fill/dispense prescriptions on an emergent basis until therapy is complete or the patient’s assigned VA Pharmacy can deliver a standard supply for continuation of therapy.

b. Scope of Work: The PBM Contractor must always provide pharmacy services for formulary management and supply a retail pharmacy network to fill/dispense emergent prescriptions up to a ten (10) days’ supply per the requirements defined in this Statement of Work (SOW).

The PBM Contractor must always ensure that its network retail pharmacies dispense prescriptions in accordance with VA Pharmacy program’s mandatory generic substitution policy, VHA Handbook 1108.08 (http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2417).

2. REQUIREMENTS:

a. General Requirements: General requirements are for non-personal services;

a. To provide First Fill prescriptions service for STVHCS facilities to include urgent/emergent vaccinations at a flat administration injection fee.

b. To provide Emergency prescriptions services up to thirty (30) days’ supply for VISN 17 facilities.

b. Specific Requirements:

(1) The contractor will provide qualified personnel who will fulfill the requirement to provide pharmacy services to include urgent/emergent vaccinations with a flat administration of injection fee enabling STVHCS to provide such services at a high level of quality.

(2) Services shall include the formulary management and dispensing of pharmaceuticals reflected on the STVHCS urgent/emergent pharmaceutical formulary listing as prescribed by authorized CBOC staff. CBOC providers prescribing urgent/emergent medications for Veterans from the formulary listing will complete a VA Initial Fill Certificate that will contain the Veteran’s full name, and a 9-digit identifier consisting of the last four digits of his/her Social Security Number, the first letter of his/her last name, and his/her four-digit birth year. The Veteran will take this certificate to a local contracted retail pharmacy to have the urgent/emergent prescription filled.

(3) The Contractor’s network retail pharmacies must always follow established clinical protocol for registration of new patients to determine a Veteran’s allergy and previous drug history.

(4) The Contractor must establish procedures that include instructions for prescribing a maximum ten (10)-day supply of medication(s) without refills when it is determined medically urgent/emergent by the CBOC providers. Retail pharmacy network prescriptions that are not dispensed to the Veteran must always be reversed seven (7) days after the date they were filled. The network retail pharmacies must always provide Veterans the same quality of services provided to beneficiaries of other commercial clients, to the extent allowed by federal law/regulation and this contract.

(5) The Contractor must always ensure that all pharmacy documents, and the receipt of the medication by the Veteran or the individual authorized by the Veteran, are in accordance with all applicable state and federal laws. The Contractor must always ensure that network retail pharmacies have procedures to reasonably assess the validity of prescriptions ordered by fax, telephone, and e-prescribing.

3. REFERENCES:

a. Federal Standards and Guidance:

(1) The Health Insurance Portability and Accountability Act (HIPAA) of 1996,Computer Security Act of 1987, Public Law 10-235

(2) OMB Circular A-123 – “Internal Control Systems”

(3) OMB Circular A-130 – “Management of Federal Information Resources,” Appendix III, “Security of Federal Automated Information Resources”

(4) 5 U.S.C. 552a, Privacy Act of 1974, 5 United States Code 552a, Public Law 99-08.

(5) 5 U.S.C. 552, Freedom of Information Act, 5 United States Code 552, Public Law

(6) 18 U.S.C. 1030 (a) (3), Fraud and related activity in connection with computers.

(7) Electronic Communications Privacy Act of 1986, Public Law 99-08, 100 Stat. 1848.

b. Agency Policy and Guidelines:

(1) VA Directive 6210, “Automated Information Systems (AIS) Security Procedures”

(2) VA Directive 6214, “Information Technology Security Certification and Accreditation Program”

c. Local Policies:

(1) STVHCS Policy Memo IT-11-01, Internet Guidelines

(2) STVHCS Policy Memo IT-11-04 Modems

(3) STVHCS Policy Memo IT-12-07, Service Level Automated Information Systems

(4) STVHCS Policy Memo 001-12-06, Remote VPN Access

(5) STVHCS Policy Memo 003-11-04, Automated Information Systems (AIS)

(6) STVHCS Policy Memo 003-14-10, Information Security Program Policy

(7) STVHCS Policy Memo 003-10-11, Information Systems Security Incident Reporting

(8) STVHCS Policy Memo 003-10-12, Sensitive Record Access and Tracking

4. SCHEDULE OF DELIVERABLES: The Contractor must always be prepared to comply with requests for information, including those originating from Congress, using company letterhead, complete sentences, and professional English. The Contractor must always comply with the request of Government and independent auditors during audits of this contract and all associated contract documentation, including but not limited to, invoices and medical records.

a. Delivery Address

Deliverables must always be submitted to the COR designated in the COR appointment letter, unless otherwise specified in the PWS.

b. Method of Delivery

Electronic copies must always be delivered using Microsoft Office suite of tools (for example, Word, Excel, PowerPoint, Project, or Access format) unless otherwise specified in the PWS or by the CO/COR.

c. Government Acceptance

The COR will have (10) business days after receipt to review deliverables, notate deficiencies, or make other comments. The Contractor must always have five (5) business days after receipt of returned deliverables to make corrections. Upon receipt of the resubmitted deliverables, the COR will have five (5) business days for final review prior to acceptance or providing documented reasons for rejection for failure to comply with Contract requirements. In the event of a rejected deliverable, the Contractor will be notified in writing by the COR of the specific reasons for rejection. The Contractor must always have five (5) business days to correct the rejected deliverable and return it per delivery instructions.

d. Schedule of Deliverables

Monthly deliverables must always be delivered on the 10th day after the end of the previous month, unless otherwise specified in the PWS.

Quarterly deliverables: VA’s fiscal year begins October 1 and ends on September 30. The initial quarterly deliverable will be delivered on the 15th day of VA Fiscal quarter following SCHD.

Task

5. QUALITY ASSURANCE SURVEILLANCE PROGRAM (QASP): The contractor will ensure quality pharmacy services are provided timely, by qualified and competent staff, and that any related PHI and EPHI is safe-guarded always in accordance with VA requirements.

6. SECURITY CONSIDERATIONS: Safeguarding PHI and EPHI is a primary concern for VA staff and must be a primary concern for contractor personnel providing services under this contract. The contractor will ensure that should contractor personnel cause and/or identify a breach of PHI or EPHI, such will be reported immediately to the Chief, Pharmacy Service, South Texas Veterans Health Care System and/or the COR.

7. PRIVACY INFORMATION: The C&A requirements do not apply, and a Security Accreditation Package is not required.

a. Information Systems Officer, Information Protection: The contractor will not have access to VA Desktop computers, nor will they have access to online resources belonging to the government while conducting services.

b. Privacy Officer: The contractor will have access to Veterans’ patient health information in the form of a Veteran’s full name, a 9-digit identifier consisting of the last four digits of his/her Social Security Number, first letter of his/her last name, and four-digit birth year provided by the VA CBOC via a hardcopy initial prescription fill certificate. The contractor will not have the capability of accessing other patient information during the services provided to the VA.

(1) SECURITY INCIDENT INVESTIGATION

(a) The term “security incident” means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/subcontractor shall immediately notify the COR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/subcontractor has access.

(b) To the extent known by the contractor/subcontractor, the contractor/subcontractor’s notice to VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information or assets were placed at risk or compromised), and any other information that the contractor/subcontractor considers relevant.

(c) With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach. Notifications need to be made in accordance with the executed business associate agreement.

(d) In instances of theft or break-in or other criminal activity, the contractor/subcontractor must concurrently report the incident to the appropriate law enforcement entity (or entities) of jurisdiction, including the VA OIG and Security and Law Enforcement. The contractor, its employees, and its subcontractors and their employees shall cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The contractor/subcontractor shall cooperate with VA in any civil litigation to recover VA information, obtain monetary or other compensation from a third party for damages arising from any incident, or obtain injunctive relief against any third party arising from, or related to, the incident.

(2) LIQUIDATED DAMAGES FOR DATA BREACH

(a) Consistent with the requirements of 38 U.S.C. §5725, a contract may require access to sensitive personal information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any SPI the contractor/subcontractor processes or maintains under this contract.

(b) The contractor/subcontractor shall provide notice to VA of a “security incident” as set forth in the Security Incident Investigation section above. Upon such notification, VA must secure from a non-Department entity or the VA Office of Inspector General an independent risk analysis of the data breach to determine the level of risk associated with the data breach for the potential misuse of any sensitive personal information involved in the data breach. The term 'data breach' means the loss, theft, or other unauthorized access, or any access other than that incidental to the scope of employment, to data containing sensitive personal information, in electronic or printed form, that results in the potential compromise of the confidentiality or integrity of the data. Contractor shall fully cooperate with the entity performing the risk analysis. Failure to cooperate may be deemed a material breach and grounds for contract termination.

(c) Each risk analysis shall address all relevant information concerning the data breach, including the following:

(b) data elements involved, including any PII, such as full name, social security number date of birth, home address, account number, disability code;

5. Ease of logical data access to the lost, stolen or improperly accessed data in light of the degree of protection for the data, e.g., unencrypted, plain text;

(d) Based on the determinations of the independent risk analysis, the contractor shall be responsible for paying to the VA liquidated damages in the amount of $31.50 per affected individual to cover the cost of providing credit protection services to affected individuals consisting of the following:

c. Records Manager:

(1) Citations to pertinent laws, codes and regulations such as 44 U.S.C chapters 21, 29, 31 and 33; Freedom of Information Act (5 U.S.C. 552); Privacy Act (5 U.S.C. 552a); 36 CFR Part 1222 and Part 1228.

(2) Contractor shall treat all deliverables under the contract as the property of the U.S. Government for which the Government Agency shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest.

(3) Contractor shall not create or maintain any records that are not specifically tied to or authorized by the contract using Government IT equipment and/or Government records.

(4) Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected by the Freedom of Information Act.

(5) Contractor shall not create or maintain any records containing any Government Agency records that are not specifically tied to or authorized by the contract.

(6) The Government Agency owns the rights to all data/records produced as part of this contract.

(7) The Government Agency owns the rights to all electronic information (electronic data, electronic information systems, electronic databases, etc.) and all supporting documentation created as part of this contract. Contractor must deliver sufficient technical documentation with all data deliverables to permit the agency to use the data.

(8) Contractor agrees to comply with Federal and Agency records management policies, including those policies associated with the safeguarding of records covered by the Privacy Act of 1974. These policies include the preservation of all records created or received regardless of format [paper, electronic, etc.] or mode of transmission [e-mail, fax, etc.] or state of completion [draft, final, etc.].

(9) No disposition of documents will be allowed without the prior written consent of the Contracting Officer. The Agency and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. Records may not be removed from the legal custody of the Agency or destroyed without regard to the provisions of the agency records schedules.

(10) Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, this contract. The Contractor (and any sub-contractor) is required to abide by Government and Agency guidance for protecting sensitive and proprietary information.

8. CONTRACT DOCUMENTS, EXIBITS, OR ATTACHMENTS

a. VISN 17 Locations and POC contact information.

Disaster Response Protocols PBM Contractor Contacts:

Customer Care – XXX-XXX-XXXX

Normal Operating Hours

Disaster Response Operating

Disaster Response Account Manager

Plan Parameters:

If you receive a call from the VISN or Retail Pharmacist:

Q: What are the criteria for a veteran who needs a non-emergent prescription refill or new prescription?

A: Veterans should contact their home VA to provide updated address information, and request refills/renewals as they normally would. For any veteran unable to reach their home VA they should call the PBM Contractor at 1-XXX-XXX-XXXX

Q: What are the criteria for re-filling urgent medications?

A: At this time, the criteria for filling these emergency fills and refills are:

1. Veteran must have either:

a. An empty vial of medications from a VA Pharmacy that is not older than 6 months and it indicates there are refills available.

b. A new prescription on a valid VA prescription form.

2. The medication is not a controlled substance

3. Veteran must present a valid ID that confirms they are the person to whom the vial or prescription belongs.

Q: How many days’ supply will be given?

A: PBM Contractor will confirm that the pharmacy is not to dispense more than a 30-day supply of any medication.

Q: What if the Veteran doesn’t have a current vial, how can he/she get refills?

A: The veteran should go to the nearest VA facility for assistance. If the veteran cannot access a VA facility, the retail pharmacy may call PBM Contractor Customer Care Center (XXX-XXX-XXXX) and a representative will provide the retail pharmacist the proper certificate number, all processing information (BIN#, etc.), and the number to a VA Pharmacist to verify drug and criteria over the phone to dispense those prescriptions.

Q: What is the number to reach a VA Pharmacist directly? (DO NOT GIVE THIS OUT TO VETERANS OR PHARMACIES)

210-379-3344 (cell)

TBD

Q: What is the number to reach a VA Pharmacist?

A: Veteran should call STVHCS Pharmacy Refill line at 1-800-209-7377 and talk to a representative. The veteran will receive a phone call from the pharmacy by the next duty day.

Q: Where is your network? Where do I send the veteran to get refills?

A: PBM Contractor has opened our pharmacy network to include any big chain drug stores within its retail pharmacy network. All they will need is their ID card and the old prescription vial. The Pharmacist will call our toll-free number to get the information needed to fill the request.

Q: I am trying to process a refill request and am having trouble with the information. Is there special processing information I need?

A: Yes, all claims processed during this emergency program are to be processed using the following certificate and group number.

a. Submit claims to _________

b. BIN# ______

c. Person Code ___

d. RXGRP# ___________

e. Processor Control # _______

Q: I have a prescription for a controlled substance. Are you able to help me fill that?

A: Unfortunately, all controlled substance prescriptions must go through the appropriate VAMC Emergency Department

If you receive a call from a Veteran:

Q: I am trying to fill my urgent prescription, where can I go?

A: You can take your prescription bottle to any big chain drug stores within the retail pharmacy network. All they will need is your ID card and the old prescription bottle to fill the prescription as long as it is emergent. The Pharmacist will call our toll-free number to get the information needed to fill the request.

Q: I can’t find my old prescription bottle. How can I refill my medications?

A: If the veteran cannot access a VA facility, the retail pharmacy may call the PBM Contractor Customer Care Center (XXX-XXX-XXXX) and a representative will provide the retail pharmacist the proper certificate number, all processing information (BIN#, etc.), and the number to a VA Pharmacist to verify drug and criteria over the phone to dispense those prescriptions.

Group Numbers affected:

b. Attachment 1 Approved Medication List for Urgent-Emergent Drug Formulary

V171STVHCS - Drug Coverage

Flag for OTC

otc

5-day supply limit

WARFARIN NA SOLUTION

Zostavax Vaccination Vial 19400 Unit

SECTION C - CONTRACT CLAUSES

C.1 CONTRACT ADMINISTRATION DATA

(continuation from Standard Form 1449, block 18A.)

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

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C671

Department of Veterans Affairs VISN17 Network Contracting Activity 7400 Merton Minter Blvd. (10N17/90C) San Antonio TX 78229

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.

FMS-VA-2(101)

Financial Services Center PO Box 149971 Austin TX 78714-9971 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

C.2 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (JAN 2017)

(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 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 original invoice and three copies (or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include—

(i) Name and address of the Contractor;

(ii) Invoice date and number;

(iii) Contract number, line item number and, if applicable, the order number;

(iv) Description, quantity, unit of measure, unit price and extended price of the items delivered;

(v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading;

(vi) Terms of any discount for prompt payment offered;

(vii) Name and address of official to whom payment is to be sent;

(viii) Name, title, and phone number of person to notify in event of defective invoice; and

(ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract.

(x) Electronic funds transfer (EFT) banking information.

(A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract.

(B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer—System for Award Management, or 52.232-34, Payment by Electronic Funds Transfer—Other Than System for Award Management), or applicable agency procedures.

(C) EFT banking information is not required if the Government waived the requirement to pay by EFT.

(2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR part 1315.

(h) Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings.

(i) Payment.—

(1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract.

(2) Prompt payment. The Government will make payment in accordance with the Prompt Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5 CFR part 1315.

(3) Electronic Funds Transfer (EFT). If the Government makes payment by EFT, see 52.212-5(b) for the appropriate EFT clause.

(4) Discount. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made.

(5) Overpayments. If the Contractor becomes aware of a duplicate contract financing or invoice payment or that the Government has otherwise overpaid on a contract financing or invoice payment, the Contractor shall—

(i) Remit the overpayment amount to the payment office cited in the contract along with a description of the overpayment including the—

(A) Circumstances of the overpayment (e.g., duplicate payment, erroneous payment, liquidation errors, date(s) of overpayment);

(B) Affected contract number and delivery order number, if applicable;

(C) Affected line item or subline item, if applicable; and

(D) Contractor point of contact.

(ii) Provide a copy of the remittance and supporting documentation to the Contracting Officer.

(6) Interest.

(i) All amounts that become payable by the Contractor to the Government under this contract shall bear simple interest from the date due until paid unless paid within 30 days of becoming due. The interest rate shall be the interest rate established by the Secretary of the Treasury as provided in 41 U.S.C. 7109, which is applicable to the period in which the amount becomes due, as provided in (i)(6)(v) of this clause, and then at the rate applicable for each six-month period as fixed by the Secretary until the amount is paid.

(ii) The Government may issue a demand for payment to the Contractor upon finding a debt is due under the contract.

(iii) Final decisions. The Contracting Officer will issue a final decision as required by 33.211 if—

(A) The Contracting Officer and the Contractor are unable to reach agreement on the existence or amount of a debt within 30 days;

(B) The Contractor fails to liquidate a debt previously demanded by the Contracting Officer within the timeline specified in the demand for payment unless the amounts were not repaid because the Contractor has requested an installment payment agreement; or

(C) The Contractor requests a deferment of collection on a debt previously demanded by the Contracting Officer (see 32.607-2).

(iv) If a demand for payment was previously issued for the debt, the demand for payment included in the final decision shall identify the same due date as the original demand for payment.

(v) Amounts shall be due at the earliest of the following dates:

(A) The date fixed under this contract.

(B) The date of the first written demand for payment, including any demand for payment resulting from a default termination.

(vi) The interest charge shall be computed for the actual number of calendar days involved beginning on the due date and ending on—

(A) The date on which the designated office receives payment from the Contractor;

(B) The date of issuance of a Government check to the Contractor from which an amount otherwise payable has been withheld as a credit against the contract debt; or

(C) The date on which an amount withheld and applied to the contract debt…