CoOpPurchaseAgreement_ADVS_Pharmacy_Services_1.19.23_-_signed.pdf

Page 3 of 5 SPO Form 106A Standard Work (Rev 11/22)

Procurement Determination:

Single-Agency Cooperative Purchase Authorization A.A.C. R2-7-1001

SECTIONS I-II MUST BE COMPLETED BY THE REQUESTOR

SECTION I - Agency Request*

1. Agency

2. Requestor 3. Email

4. Title 5. Telephone

* For limited delegation agencies, please work with your Enterprise Procurement Services (EPS) liaison.

SECTION II - Background

6. Description

7. Contractor

8. Contract ID 9. Purchase Type

10. Maximum End Date

11. Estimated Spend

12. Detail the efforts made to secure a contract for the specific Materials or Services requested and explain why purchasing from a Cooperative Contract (piggyback) is in the best interest of the State per Technical Bulletin 005.

See email attachment

Arizona Pioneers' Home

Jessica Sullivan jessica.sullivan@aph.az.gov

Superintendent 928-277-2763

Pharmaceutical Services for the Arizona Pioneers' Home

Guardian Pharmacy of Arizona dba Saliba's Extended Care Pharmacy

CTR061131

07/31/2027 400,000

- Full Use of Contract

Page 4 of 5 SPO Form 106A Standard Work (Rev 11/22)

13. Was the contract awarded through the competitive process? A.A.C. R2-7-1003(B)(1)

14. Date of request 15. Requester Signature

16. Requester: Upon completion of Section I and II, send this signed form to Contract Owner listed in the eProcurement System for review

Approval of this request does not allow for agencies to exceed their delegated authority.

TO BE COMPLETED BY THE CONTRACT OWNER

SECTION III - Contract Owner Review

17. Comments, conditions, and restrictions (as applicable)

18. I acknowledge that upon approval of SPO Form 106A, the Contract will require an amendment to add the additional agency and the additional agency will need to be added as a user in the state’s eProcurement System. This completed form will be included in the request to the help desk.

19. Print Name 20. Title

21. Signature 22. Date of Review

23. Contract Owner: Upon completion of Section III, send this signed form to SPOCompliance@azdoa.gov and cc Requestor for processing

Elena Adame Chief Procurement Officer

12.21.2022

X

12/16/2022

- Yes

Page 5 of 5 SPO Form 106A Standard Work (Rev 11/22)

SECTION IV - Approval

TO BE COMPLETED BY PROCUREMENT AUTHORITY

24. Determination

25. Approved Expiration Date

26. Comments, conditions or restrictions (as applicable)

27. Print name 28. Date

29. Title 30. Signature

AGENCY NOTICE: This is an official written determination in response to a procurement authorization request. The original request shall be maintained in the State Procurement Office.

31. Use this additional section as necessary

- Request Authorized

7/31/27

Jessica Klein

Deputy Assistant Director of Compliance

Jan 20, 2023 https://azadoagov.na1.echosign.com/verifier?tx=CBJCHBCAABAAAC6XPUhXpqObasX1vLlrH0hTw7Efc3vu

1/19/23, 12:46 PM State of Arizona Mail - Pharmaceutical Services Contract https://mail.google.com/mail/u/0/?ik=40f451e563&view=pt&search=all&permthid=thread-f%3A1755478533239866320%7Cmsg-f%3A1755478533239… 1/1

Kerry Wells <kerry.wells@azdoa.gov>

Pharmaceutical Services Contract 1 message

Elena Adame <eadame@azdvs.gov> Thu, Jan 19, 2023 at 11:59 AM To: Kerry Wells <kerry.wells@azdoa.gov> Cc: Ken Sanchez <ken.sanchez@azdoa.gov>, Jessica Sullivan <Jessica.Sullivan@aph.az.gov>, Jack Beasley <jbeasley@azdvs.gov>

Kerry, Background: The Pioneer Home was part of ADVS previous Contract No. ADVS17-154060. ADVS experienced a high turn around last year and the procurement officer inadvertently left out the Pioneer Home of the new solicitation. ADVS solicited for Pharmaceutical Services. We received 3 proposals from Pharmacy Corporation of America, Guardian Pharmacy dba Salibas and Neighborcare (CVS). Salibas' pricing was fair and reasonable. This supplier can also support the third party billing requirement. Please let me know if you need anything else.

Respectfully, Elena Adame

Chief Procurement Officer

Arizona Department of Veterans’ Services Administration Division

3839 N. 3rd Street Suite 209

Phoenix, AZ 85012

Office: 602-234-8404

Cell: 602-350-5717

How are we doing? Let us know at: http://bit.ly/advsfeedback

Arizona Department of Veterans' Services - www.azdvs.gov LEGAL NOTICE: Under Arizona's Public Records Law, all e-mails sent by or to me on this state-owned e-mail account may be subject to public disclosure. This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Click HERE for detailed Notices including HIPAA overview.

http://www.azdvs.gov/ https://dvs.az.gov/agency-email-disclaimer-notice https://www.google.com/maps/search/3839+N.+3rd+Street+Suite+209+%0D%0A%0D%0A+Phoenix,+AZ+85012+%0D%0A%0D%0A+Office:+602?entry=gmail&source=g https://www.google.com/maps/search/3839+N.+3rd+Street+Suite+209+%0D%0A%0D%0A+Phoenix,+AZ+85012+%0D%0A%0D%0A+Office:+602?entry=gmail&source=g https://www.google.com/maps/search/3839+N.+3rd+Street+Suite+209+%0D%0A%0D%0A+Phoenix,+AZ+85012+%0D%0A%0D%0A+Office:+602?entry=gmail&source=g http://bit.ly/advsfeedback

SPO Form 106A Single-Agency Cooperative Purchase Authorization_11.15.2022