CTR051357_MedImpact_Formulary_Letter_--12-27-2021.pdf

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Attached to
Master Agreement AZ|CTR051357
Contract number
CTR051357
Issued by
Arizona

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This document is a formal letter dated December 27, 2021, from MedImpact Healthcare Systems, Inc. to Renee Uliassi, Statewide Procurement Manager at the Arizona Department of Administration (ADOA). The letter is sent via email from MedImpact's office located in San Diego, California.

The letter specifies the Commercial formulary details for the Arizona Department of Administration, effective January 1, 2022. The formulary will be MedImpact's standard MedPerform formulary with a Medium edit package. Rebates will be submitted through channels that allow for NDC (National Drug Code) level rebate reporting. No specific pricing, contract amounts, or additional service details are provided in this communication.

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A 10181 Scripps Gateway Ct, San Diego, CA 92131

P 800.788.2949

MedImpact.com

Sent Via Email Renee Uliassi Statewide Procurement Manager State Procurement Office Arizona Department of Administration 100 N. 15th Avenue, Suite 402 Phoenix, AZ 85007

December 27, 2021

Dear Ms. Uliassi, The Commercial formulary in place for MedImpact Healthcare Systems, Inc.’s (MedImpact) Client, Arizona

Department of Administration (ADOA) effective January 1, 2022, is MedImpact’s standard MedPerform formulary with Medium edit package with rebates submitted through channels that allow for NDC level rebate report.

Sincerely, Erin Russell Account Executive

File details come from the government source that posted it. Updated .