ND+WIC+Service+Agreement.pdf

PURCHASE OF SERVICE AGREEMENT

NORTH DAKOTA DEPARTMENT OF HEAL TH

SFN 53772 (01-2020)

Contract Number CFDA Name PF21.039 Not applicable FAIN Number Contract Type (Check One) Start Date Not applicable 181 Acquisition □ Research 10/1/2021 Federal Award Date Federal Awarding Agency Not applicable Not applicable

- ----CFDA Number Not applicable End Date 9/30/2023

This contract is not effective and expenditures related to this contract should not be incurred until all parties have siQned this document.

Title of Project/Program North Dakota Department of Health (NDDoH) Project Code WI C Infant Formula Rebate ProQram Not aoolicable Contractor Name Project Director Abbott Laboratories Inc. Amanda Varriano Address Address 3300 Stelzer Road 600 East Boulevard Ave., Dept 301 City/State/ZIP Code City/State/ZIP Code Columbus OH 43219 Bismarck, ND 58505-0200 Contact Name Contact Name Kori Stenzel Amanda Varriano Telephone Number Telephone Number 614-624-5816 701-328-4531 Email Address Email Address kori.stenzel(@abbott.com alvarriano@nd.aov

NDDoH Cost Share Contractor Cost Share Total Costs --- Amount Awarded $0 $0 $0 Previous Funds Awarded $0 $0 $0 Total Funds Awarded $0 $0 $0 Scope of Service Contractor will shall supply and pay a rebate on all infant formula forms of infant formula (including any new infant formulas and subcontracted infant fortnula) it produces that the NDDoH choose to issue, exceot exemot infant formula.

Reporting Requirements The NDDoH will calculate the rebate for infant formula products and provide a monthly invoice to the Contractor. Contractor will process the rebate regardinQ the NDDoH's rovided invoice on a monthly basis.

Special Conditions .•

The NDDoH participated with the State of Missouri's invitation for bid number IFBC30034902100089 for the WIC Infant Formula Rebate Program which was awarded to the Contractor under the State of Missouri's contract number CC210089001.

Cooperative Purchase - This Purchase of Service Agreement is a cooperative purchasing contract established pursuant to North Dakota Centurv Code INDCC) sections 54-44.4-13

This Purchase of Service Agreement is subject to the terms and conditions incorporated either directly or by reference in the following: (1) Requirements Addendum for Purchase of Service Agreements issue� the NDDoH as signed by Contractor for the period of July 1, 2021 to June 30, 2023 [Fiscal Services Use Only: Requirements Received] and

12) aoolicable State and Federal reoulations.

Date

1/012-r

Evidence of Contractor's Acceotance Signature

�a,,, �, -r�/1

Typed �ame/Title of Authorized Represenfiftive Kori Stenzel, Sr. Manager WIC Contracts

Date Signature

Typed Name/Title of Authorized Representative

Date Signature

Typed Name/Title of Authorized Representative

Evidence of State Acceptance Date Signature 9/3/2021 b� �u..,...,,._r-

Typed Name/Title of Authorized Representative Deanna Askew, Director, Family Health and Wellness North Dakota Department of Health

Dt}¼ 1)-d}I Signature

!if71tJJt�✓ Typed Name/Title of Authorized Represefltative Brenda M. Weisz, Chief Financial Officer North Dakota Deoartment of Health Date Signa�re

Typed Name/Title of Authorized Representative Tricia Opp, Contract Administrator North Dakota State Procurement Office

If attachments are referenced, they must be returned with the signed award.

If vou did not receive attachments as indicated. contact the Proaram Director identified above.

9/7/2021