CSP016317_Contract_REV.pdf

Index No.: DDD003

Eff. Date: 10/10/23

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 CONSULTING SERVICES AND PHARMACEUTICALS

CONTRACT NUMBER: CSP016317 EFFECTIVE DATES: 10/10/23 TO 06/30/26

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

SRC0000007454 that opened on 07/05/23. 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 Department of Developmental Disabilities 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:

https://procure.ohio.gov/

Eff. Date: 10/10/23

COST SUMMARY FORM

Pharmacy Consulting Services and Pharmaceuticals

CSP016317

UNSPSC CATEGORY CODE: 85000000

Description

Cost

Per Prescription Dispensing Fee No Charge

Pharmaceutical Consulting Services $ 55.00 /hr.

Equipment Rental Fee No Charge

Percentage Discount off Brand Specific at the average wholesale price (AWP) for non-third party, Medicaid, Medicare Part B or D, billable prescriptions AWP – 19.5%

Percentage Discount off the Generic at the average wholesale price (AWP) for non-third party, Medicaid, Medicare Part B or D, billable prescriptions AWP - 93%

Over-the-Counter Drugs will be billed at the Wholesale Acquisition Cost (WAC). At WAC Price

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.

Eff. Date: 10/11/23

CONTRACTOR INDEX

CONTRACTOR AND TERMS: BID CONTRACT NO.: CSP016317

0000189971 DELIVERY: As Specified PCA Corrections LLC

DBA Synchrony Columbus Pharmacy TERMS: Net 30 4014 Venture Ct.

Columbus, OH 43228

*CONTRACTOR'S CONTACT:

Telephone: (866) 308-2312 Matt Zickmund FAX: (866) 726-2711 E-Mail: Matt.Zickmund@synchronyhs.com

*Indicates updated Contractor contact information.

mailto:Matt.Zickmund@synchronyhs.com

Eff. Date: 11/01/23

SUMMARY OF AMENDMENTS

Amendment

Number Effective

Date Description

1 11/01/23

This amendment is issued to update the contact information for the Contractor.

Additionally, this amendment is issued to add the Summary of Amendments page.

All other prices, terms, and conditions remain unchanged.