CSP008621_REV_Contract.pdf

Index No.: DOH007

Eff. Date: 07/01/25

STATE OF OHIO

DEPARTMENT OF ADMINISTRATIVE SERVICES

GENERAL SERVICES DIVISION

OFFICE OF PROCUREMENT SERVICES

4200 SURFACE ROAD, COLUMBUS, OH 43228-1395

MANDATORY USE CONTRACT FOR: PHARMACY BENEFITS MANAGER FOR THE RYAN WHITE PROGRAM

CONTRACT NUMBER: CSP008621 EFFECTIVE DATES: 07/01/22 TO 06/30/25

* Renewal through 06/30/26

The Department of Administrative Services has accepted Proposals submitted in response to Request for Proposal (RFP) No.

SRC0000002534 that opened on 03/16/22. The evaluation of the Proposal responses has been completed. The Offeror listed herein has been determined to be the highest-ranking Offeror and has been awarded a Contract for the services listed. The respective Proposal response including, Contract Terms & Conditions, any Proposal amendment, special Contract Terms & Conditions, specifications, pricing schedules and any attachments incorporated by reference and accepted by DAS become a part of this Services Contract.

This Requirements Contract is effective beginning and ending on the dates noted above unless, prior to the expiration date, the Contract is renewed, terminated, or cancelled in accordance with the Contract Terms and Conditions.

This Requirements Contract is available to the Ohio Department of Health as applicable.

The agency is eligible to make purchases of the contracted services in any amount and at any time as determined by the agency. The State makes no representation or guarantee that department will purchase the volume of services as advertised in the Request for Proposal.

This Requirements Contract and any Amendments thereto are available from the DAS Web site at the following address:

www.ohio.gov/procure

*Indicates mutual renewal for six months, effective 7/1/25.

Index No. DOH007 Eff. Date: 07/01/22 Page No.: 2

MUTUALLY AGREED TO MODIFICATIONS TO THE CONTRACT:

1. Clarification Letter – response dated 04/18/22

2. Best and Final Offer Letter – response dated 04/22/22

3. Affirmation and Disclosure Form – response dated 05/04/22

Eff. Date: 07/01/22 Page No.: 3

COST SUMMARY FORM

Pharmacy Benefits Manager for the Ryan White Program

CSP008621

UNSPSC CATEGORY CODE: 80111502

All pricing elements shall be based upon the Contractor’s Best and Final Offer (BAFO) of April 21,2022.

All costs must be in U.S. Dollars.

The State will not be responsible for any costs not identified.

There will be no additional reimbursement for travel or other related expenses.

CONTRACTOR INDEX

CONTRACTOR AND TERMS: BID CONTRACT NO.: CSP008621

0000249853 CaremarkPCS Health, LLC. DELIVERY: As Specified CVSHealth 1 CVS Drive Woonsocket, RI 02895 TERMS: Net 30

CONTRACTOR'S CONTACT:

Yordan Mosquera Telephone: (305) 968-7107

FAX: (401) 335-7297

E-Mail: yordans.mosquera@cvshealth.com mailto:yordans.mosquera@cvshealth.com

Eff. Date: 07/01/25 Page No.: 4

SUMMARY OF AMENDMENTS

Amendment

Number Effective

Date Description

1 07/01/25

This amendment is issued to notify that as a result of mutual agreement between the State of Ohio and the Contractor, this contract is renewed for an additional twelve months, effective 07/01/25 through 06/30/26. All other prices, terms and conditions remain unchanged.