Attachment 1-Offeror Qualification Form.pdf

This is an Offeror Qualification Form for a state and local contract opportunity with the State of Hawaii for audit services of pharmacy billings. The form requests that interested contractors provide comprehensive information about their firm's qualifications to perform auditing services of pharmacy billings for medication services and drugs for HSH's patients. Contractors must complete the form with their exact legal name, street address, city, state, zip code, and primary contact information including name, cell phone, telephone, fax, and email address. If applicable, contractors must also provide identical contact and address information for any subcontractors involved in the engagement. The form requires a detailed statement of experience and qualifications demonstrating the contractor's ability to deliver the requested pharmacy billing audit services.

Additionally, the form mandates that offerors provide at least three professional references from clients for whom the offeror has performed pharmacy billing audit services within the past five years. For each reference, contractors must submit the name of the firm, address, contact person name, telephone number, and email address. The qualification form serves as a screening mechanism to evaluate contractor capacity and track record in pharmacy billing audit services prior to formal bid evaluation.