MMCAP VRF for RFP 32415 Pharmaceuticals and Over the Counter Products.docx

SECTION 3 – VENDOR RESPONSE FORM

INSTRUCTIONS: Fill in the information requested below, sign, and submit with your response.

1. Responder’s Contact Information

Company’s Full Legal Name:

Business Address:

Company Website:

Federal Employer Identification Number:

Primary Contact Person’s Name:

Title:

Telephone Number:

E-Mail Address:

Alternate Contact Person:

Title:

Telephone Number:

E-Mail Address:

Admin Fee Contact Person:

Telephone Number:

E-Mail Address:

Membership Contact Person:

Telephone Number:

E-Mail Address:

Reporting/Data Contact Person:

Telephone Number:

E-Mail Address:

2. Pass/Fail Criteria

Does Responder comply with each term?

cGMP Responder certifies it is compliant with the Food and Drug Administration’s current “Good Manufacturing Practices” (cGMP) (as codified in 21 C.F.R. § 201-211) and the current United States Food, Drug, and Cosmetic Act, if applicable

Drug Supply Chain Security Act (DSCSA) Responder is compliant with all currently applicable sections of the Drug Quality and Security Act Title II.

Authorized Wholesalers/Chargeback System Responder has products available from at least two of MMCAP Infuse’s three Authorized Wholesalers (AmerisourceBergen, Cardinal Health, and Morris & Dickson) AND has a chargeback system in place with these wholesalers. If Responder checks “No,” an explanation must be provided in Responder’s submission.

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Responders that have not completed each section will not be further considered.

3. Scored Criteria (Preferences further defined in section 2.5 of this RFP document)

Price Increases Responder agrees to fixed pricing for the term of the contract, through June 30, 2024 as defined in Articles 1.2 through 1.5 in the Sample Agreement Terms and Conditions.

Administrative Fee Data Responder will provide data in the format and timeframe defined in Article 7 of the MMCAP Infuse Sample Agreement Terms and Conditions

Administrative Fee Responder agrees to offer a 3% administrative fee on all products through June 30, 2024.

Communication via Electronic Data Interchange (EDI) Responder’s chargebacks, contract product, and contract pricing communication with MMCAP Infuse’s Authorized Wholesalers is via EDI.

4. Requirements for a complete submission The documents listed below are required for a complete proposal. Instructions are split into two groups, Responders that do not have a current contract and Responders who have a current pharmaceutical contract whose Attachment A (listing of contracted products) expires on June 30, 2023.

Responders should use the following checklist(s) prior to sending their responses to ensure a complete response is submitted:

New Responders:

Solicitation Form 1: General Solicitation Requirements (Read) Vendor Response Form, Section 3 (this document) Exceptions to the MMCAP Infuse Sample Agreement Terms and Conditions, Exhibit A, submitted in Microsoft Word unlocked and unrestricted for editing Solicitation Form 1: General Solicitation Requirements (Read) Solicitation Form 2: Certification Regarding Lobbying Form (submitted in PDF) Solicitation Form 3: Workforce Certificate (submitted in PDF) If applicable, Solicitation Form 4: Veteran Owned Preference (submitted in PDF) Products and Pricing, Section 4, consisting of:

Electronic submission via ePro, at https://mmcap.buyspeed.com Electronic Excel spreadsheet via email, of products and pricing that is submitted by Responder in ePro. Name this Excel spreadsheet Exhibit B and include it with your response.

If applicable, Exhibit C, Additional Proposed Products (submitted in Excel) For each product being proposed, list the manufacturing facility location(s) where the product is manufactured Incumbents:

Solicitation Form 1: General Solicitation Requirements (Read) Vendor Response Form, Section 3 Products and Pricing, Section 4, consisting of:

Electronic submission via ePro: https://mmcap.buyspeed.com Electronic Excel spreadsheet via email, of products and pricing that is submitted by Responder in ePro. Name this Excel spreadsheet Exhibit B and include it with your response

If applicable, Exhibit C, Additional Proposed Products (submitted in Excel) For each product being proposed, list the manufacturing facility location(s) where the product is manufactured

5. Alterations or Additions to the State’s Agreement (Responders who DO NOT have a current contract) If you wish to take an exception to the State’s Agreement (Exhibit A), please indicate that below and attach any appropriate documentation.

None See attached document detailing proposed alterations and/or additions to the State’s General Terms.

The following signature requires a physical signature or official eSignature (such as DocuSign) By signing, I acknowledge that the Responder accepts, without qualification, all terms and conditions stated in this solicitation (including the sample contract) except those clearly outlined as exceptions above.

Signature:

Printed Name:

Title: Date:

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