Atch D- Statement of Work Pharmacy 9 SEP 25.pdf

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STATEMENT OF WORK: 9 September 2025

It is the intent to acquire non-personal professional pharmacist and pharmacy technician services for Pharmacy

Services for a 12-month base period with four (4) one (1) year option periods. The intent of this contract is to establish a method whereby Fort Yuma Health Center (FYHC); Colorado River Service Unit (CRSU) for Parker IHS Indian Hospital and Peach Springs Health Center; Hopi Health Care Center (HHCC); Elko Service

Unit (ESU); Phoenix Indian Medical Center (PIMC); and Whiteriver Service Unit (WRSU) may minimize disruptions in pharmacy services because of staff changes and shortages over the next (5) years. PIMC and WRSU are projected to begin services in option year one (1). The specific need for pharmacists and pharmacy technicians is difficult to predict and therefore it is likely that the service units may not use all services the full year, however having them available when the need arises will minimize service disruptions. Requests for contractor coverage will be on an as needed basis due the changing needs of the clinics.

All responses to this solicitation shall contain a complete profile and current work history of the candidate(s) presented, including copies of licensure, certifications and education.

Selected candidate shall undergo the Indian Health Service mandated security clearance requirement prior to commencement of services at the various Service Units. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check of candidates through the office of the inspector general's exclusion list at http://exclusions.oig.hhs.gov/.

LOCATIONS:

All services shall be performed at the following locations:

Parker Indian Health Center 12033 Agency Road

Parker, AZ 85344

Peach Springs Health Center

943 Hualapai Way

Peach Springs, AZ 86434

Hopi Health Care Center

P.O. Box 4000

Ship to: Hwy 264, Mile Marker 388 Polacca, AZ 86042

Fort Yuma Health Center 401 Picacho Road

Winterhaven, CA 92283

Phoenix Indian Medical Center 4212 N 16th Street

Phoenix, AZ 85016

Southern Bands Health Center (ESU)

515 Shoshone Circle

Elko, NV 89801 http://exclusions.oig.hhs.gov/.%20D

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Whiteriver Service Unit:

Whiteriver Indian Hospital

200 West Hospital Drive

Whiteriver, AZ 85941

AND

Cibecue Health Center 2 West Third Street

Cibecue, AZ 85911

SHIFTS:

Contractors will be expected to abide by the Caregiver Identification Policy that specifies uniform requirements for staff and shift hour assigned, modalities of charting and care delivery and other rules and regulations of the facility.

Contractor(s) who accept full-time assignments shall attend assigned meetings. Work week is

Sunday 12:00 AM to Saturday 11:59 PM.

Fort Yuma Health Center, Hopi Health Care Center, Southern Bands Health Center (ESU) & Peach Springs

Health Center

Pharmacist Full-Time Shift Schedules: 8-hour shifts:

Monday 0800 – 1700 *

Tuesday 0800 – 1700 * Wednesday 0800 – 1700 *

Thursday 0800 – 1700 *

Friday 0800 – 1700 *

Parker Indian Health Center

Pharmacist Full-Time Shift Schedules: 8-hour shifts:

Monday 0830 – 1730 * Tuesday 0830 – 1730 *

Wednesday 0830 – 1730 * Thursday 0830 – 1730 *

Friday 0830 – 1730 *

Phoenix Indian Medical Center (Option Year 1):

Pharmacist and Pharmacy Technician Full-Time Shift Schedules 8-hour shifts:

Hours needed to cover emergency leave, vacancies, and other staff shortages (may include weekends and holidays if needed):

Pharmacists: 1-hour lunches Day: 0830 – 1730 (8:30 a.m. to 5:30 p.m.)*

Day: 0900 – 1800 (9:00 a.m. to 6:00 p.m.)*

Day: 1000 – 1900 (10:00 a.m. to 7:00 p.m.)*

Day and Night: 1300 – 2200 (1:00 p.m. to 10:00 p.m.)* Day and Night: 1500 – 2400 (3:00 p.m. to 12:00 a.m.)*

Pharmacy Technicians: ½ hour lunches Day: 0500 – 1330 (5:00 a.m. to 1:30 p.m.)*

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Day: 0700 – 1530 (7:00 a.m. to 3:30 p.m.)*

Day: 0800 – 1630 (8:00 a.m. to 4:30 p.m.)*

Day: 0930 – 1800 (9:30 a.m. to 6:00 p.m.)*

Day: 1030 – 1900 (10:30 a.m. to 7:00 p.m.)*

Day and Night: 1130 – 2000 (11:30 a.m. to 8:00 p.m.)* Day and Night: 1530 – 0000 (3:30 p.m. to 12:00 a.m.)*

Whiteriver Service Unit - Includes Whiteriver Indian Hospital and Cibecue Health Center (Option Year 1)

Pharmacist Full-Time Shift Schedules: 8-hour shifts with ½ hour lunches:

Day shifts only:

0800 – 1630 (8:00 a.m. to 4:30 p.m.)

0830 – 1700 (8:30 a.m. to 5:00 p.m.)

0900 – 1730 (9:00 a.m. to 5:30 p.m.)

0930 – 1800 (9:30 a.m. to 6:00 p.m.)

*Lunch breaks are 1- hour lunch for Pharmacists and ½ hour lunch for Pharmacy Technicians for 8-hour shifts and the Government does not pay for time taken for lunch.

Total shifts worked annually shall be in accordance to the total number of work hours allocated for the year by service units.

Unless exempt, medical professionals covered by the Fair Labor Standards Act on a compressed schedule must receive overtime pay for hours worked over 80 in a two week pay period, as defined by the HHS payroll calendar.

Contractors may be scheduled in excess of 80 hours in a defined pay period.

Contractors who accept long full-time assignments (1 continuous week of 7 days or more) shall attend meetings and training and participate fully as staff members.

Please Note: The contractor shall provide and identify at least (3) weeks in advance of the scheduled performance dates, the credentialed and cleared candidates for the scheduled shifts. Contractor will be required to obtain security clearance and credentialing/privileging requirements for each candidate submitted for working at each service unit locations.

RATE SCHEDULE:

The unit price paid to the Contractor shall be considered as payment in full for services provided under this award. In no way, unless directed by the IHS, shall any provider attempt to bill or collect from any IHS patient, or from any alternate resource for which the patient may be eligible.

Contractor shall provide an hourly fixed rate and hourly overtime fixed rate for “As Needed Basis” estimated hours. However, it is not expected that contractors will be asked to work overtime as a general rule and will be limited as much as possible for those who are working under this contract. Overtime would only be requested when the need to finish patient care precludes the contractor leaving on time or in an emergency situation. The

Government will pay an hourly flat fixed rate and a rate for overtime. The Contractor shall be paid only for actual time services are performed under the terms of the contract at the hourly fixed rate and if needed overtime rate. Contractors may be asked to work nights, weekends, or holidays based on patient care needs.

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QUALIFICATION/CERTIFICATION – PROFESSIONAL AND RELATED SERVICES:

Contractor shall provide medical and related professionals with experience in these areas.

Pharmacist:

a. Years of Experience: Minimum of (2) years of experience as a registered Pharmacist.

b. Minimum Education: Bachelor or Doctor of Pharmacy Degree from an Accredited Pharmacy

School Program.

c. Current certification in BLS (Basic Life Support).

d. Applicants must have an active, unrestricted, and free of disciplinary action license as a Pharmacist in a State, District of Columbia, the Commonwealth of Puerto Rico, or a Territory of the United

States.

Pharmacy Technician:

a. Years of Experience: Minimum (1) year of experience as a certified Pharmacy Technician

b. Minimum Education: Active unrestricted Pharmacy Technician Certification.

c. Current certification in BLS (Basic Life Support).

STATEMENT OF WORK:

The overall scope of this contract is to provide qualified and experienced pharmacists and pharmacy technicians under a Government service contract. The Contractor(s) will be expected to have the necessary education, training, licensing, previous work experience and competence in being able to provide the services within the pharmacy(s). Work performance shall be performed according to the requirements and conditions contained in this Statement of Work. The contract resulting from this solicitation includes:

The Contractors(s) shall be expected to assist and provide services and duties as may be requested for the normal operational requirements for the Service Unit Pharmacy. The contractor shall provide work that is consistent with the guidelines and procedures of the IHS. Failure of the contractor to meet these standards can result in cancellation of this contract or at a minimum a request that the Contractor(s) be dismissed and a new Contractor(s) be dispatched. The contractor’s performance and abilities shall be evaluated based upon performance standards that are contained in this Statement of Work.

The Contractor(s) shall prepare and complete in a timely manner the required documents, in accordance with the SERVICE UNITS Medical By-Laws and/or Clinic Policy. Chart notes (where applicable) are to be completed on the day services are rendered and specifically, with rare exception, immediately after finishing with the patient. During the performance of their duties, the contractor shall provide for the consistent performance of patient care processes according to the standards for AAAHC/TJC accreditation within IHS.

The Contractor(s) shall:

1. Be proficient in writing, typing and have a basic working knowledge and understanding of computer hardware and software applications.

2. Must provide copy of resume for file and Basic Life Support certification. Contractor file will be kept by the Pharmacy Department Office for verification of license; also, file will contain continuing education, and competency assessments.

3. Have sufficient knowledge, competence and experience in providing these services on a regular schedule at SERVICE UNITS.

4. Possess sufficient initiative, interpersonal relationship skills, social sensitivity and appropriate professional behavior such that he/she can relate constructively to IHS employees, contractors, vendors and individuals from the Native American community.

5. Have a valid state driver’s license from any of the 50 United States or the Commonwealth of Puerto

Rico.

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6. Not have any work or health restrictions, which could directly or indirectly interfere with the performance of providing services.

7. Maintain acceptable standards of personal hygiene, grooming and professional attire such that their image as a Federal contractor is compatible with the expectations of the IHS staff.

8. Be required to utilize the electronic health record for chart documentation (where applicable) after receiving training.

9. Be sensitive to the unique culture factors of the people they serve, which may include use of an interpreter as necessary in communication of services being rendered. Unique cultural factors that may contribute to the patient’s treatment include: use of their language communications; village and tribal customs; use of traditional healers; isolation; housing conditions and lack of resources.

10. Have tact and diplomacy while working in stressful situations.

CONDITIONS FOR REMOVAL/REPLACEMENT OF PHARMACY PERSONNEL:

As mutually agreed between the Contracting Officer and the Contractor there may be grounds for removal and/or replacement of a pharmacy personnel. The Contractor(s) shall be removed from an IHS facility if services are not performed in accordance with terms and conditions of this award. The Contractor shall relieve contracted staff within 24 hours of notice and, if a replacement is needed, the replacement should be recruited within one week of the removal.

CONTRACTOR REQUIREMENTS:

Upon award, the selected medical professional(s) shall undergo Indian Health Service (IHS) mandated security clearance for work on-site based upon the selected service unit. The security pre-clearance requirement must be adhered to; the process includes a fingerprint check and a screen check through the Office of the Inspector

General's exclusion list at http://exclusions.oig.hhs.gov/ and www.sam.gov (best checked through www.verifycomply.com as this checks all exclusion lists).

Pharmacy services by the contractor will include: Practicing within the limits of their pharmacy job title professional qualification and within the standards of the State of pharmacist licensure. In providing these services, the Contractor shall assume and provide guidance and quality of treatment to patients under the terms of this contract, as is provided to the general public.

Pharmacist:

The work to be performed can include, but is not limited to, the following:

1. Screen patient charts to ensure medication orders are aligned with the chart note as well as lab work, vitals, allergies, etc.

2. Process new medication orders.

3. Fill prescription orders when needed.

4. Check filled prescription orders for accuracy.

5. Educate patients on medication therapy.

6. Provide patient education.

7. Work in a collaborative fashion with the pharmacy team and providers to ensure timely and accurate pharmaceutical services.

8. Answer provider questions regarding drug therapy and question providers when appropriate to ensure the proper medication, in the proper dose and dosage form is dispensed to the patient.

9. Recognize life-threatening emergencies, initiate and maintain resuscitation measures and other emergency procedures as appropriate to the situation.

10. Recognize adverse reactions to medications, treatments, and procedures and initiate interventions as appropriate to the situation.

11. Answer and screen telephone calls, take refill requests, and input outside prescriptions into the http://exclusions.oig.hhs.gov/ http://www.sam.gov/ http://www.verifycomply.com/

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12. Perform controlled substance audits as/if directed

13. Help put away order as needed.

14. I.V. admixtures and inpatient drug distribution will be carried out based on patient care needs and following Service Unit policies and procedures.

15. Administer immunizations (certification required)

16. The contractor’s employee(s) shall participate in training and competency activities including:

• Annual safety and infection control

• Other mandatory training as assigned

Pharmacy Technicians:

The work to be performed can include, but is not limited to, the following:

1. Fill prescription orders

2. Reconstitute and compound medication orders based on patient care needs and following Service

Unit policies and procedures.

3. Fill clinic and ward drug supply orders

4. Maintain inventory of stock and I.V. bulk solutions

5. Prepackage medication into unit-of-dispensing sizes

6. Clinic and ward inspections

7. Dispense medication refills

8. Other related duties as assigned

9. The contractor’s employee(s) shall participate in training and competency activities including:

• Annual safety and infection control

• Other mandatory training as assigned

Work performance is reviewed for conformance to IHS policy, procedures and accepted professional practices.

Character Investigation / Standards of Conduct:

Contracted Pharmacists and Pharmacy Technicians shall provide services consistent with the highest standards of professional ethics, including confidentiality and patient rights. Contracted Pharmacists and

Pharmacy Technicians are subject to a character investigation in accordance with Public Law 101-630, Indian Child Protection and Family Violence Prevention Act, and Public Law 101-647, Crime Control Act.

Contracted Pharmacists and Pharmacy Technicians shall abide by the Service Unit’s Standard of Conduct as well as policies and procedures, and shall maintain satisfactory standards of competence, conduct, appearance, and integrity.

CHILD CARE NATIONAL AGENCY CHECK & INVESTIGATION (CNACI):

In accordance with the Child Care National Agency Check and Investigation (CNACI) directive, implemented by the

IHS, the following documents will be required from the Contractor and all employees they utilize under this awarded contract:

1. DHHS Application Background Survey.

2. DHHS/IHS Required Application Questionnaire for Child Care Positions.

3. IHS – Release of Personal Information.

4. SF-85 Questionnaire for Non-Sensitive Positions.

5. GSA Form 176 – Statement of Personal History.

6. FD-258 Federal Bureau of Investigation Fingerprint Analysis Chart

A Contractor whose duties and responsibilities involve regular contract or control over children is subject to a character investigation as required by Public Law 101-630, the Indian Child Protection and Family Violence

Prevention Act. The Phoenix Area IHS Office of Human Resources or the IHS Service Unit conducts these

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Contracting Officer, in consultation with the Human Resource Officer, an investigation has already been conducted and is on file. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contractor must not have unsupervised contact with the Indian Children

Credentialing and Fingerprinting:

Contracted Pharmacists and Pharmacy Technicians will undergo the same credentialing and fingerprinting process as permanent IHS Pharmacists and Pharmacy Technicians.

Credentialing and fingerprinting is a two-part process that takes place once the award has been issued.

First, the Contractor will be required to submit the following list of documents for each Contracted

Pharmacist and Pharmacy Technician for credentialing with IHS under this contract:

1. Current resume or CV

2. OF-306 – Declaration for Federal Employment (All questions must be answered;

signature and date in box 17a must be completed.)

3. OF-306 Addendum to the OF-306 (Declaration for Federal Employment)

4. IHS Provisional Access Memo

5. Protecting Children from Sexual Abuse in Health Care Settings (Provide a copy of the

Certificate of Completion.)

6. No FEAR Act Training (Provide a copy of the Certificate of Completion.)

7. OFI-86C form

▪ Include permanent address as well as any temporary addresses used while on assignments.

▪ Fill in items 1 through 6, plus item 13.

▪ Leave item 14 blank (IHS personnel security will fill this in.)

▪ Return the form in fillable format

8. Applicable state forms – these will be identified by IHS personnel security. To preview which forms will be required, please reference Child Care Agency Guide (11/01/21).

9. HHS-745 Section A

10. Two IDs (driver’s license and social security card – names must match and be unexpired)

11. Pharmacist license(s) and Pharmacy Technician certification – must be active/unrestricted

12. BLS certification

NOTE: No photo submission of forms, please have the forms scanned. Wet signature and date is highly recommended. No PDF signatures will be accepted.

Please note: IHS reserves the right to reject proposed Contracted Pharmacists and Pharmacy Technicians if the Clinic Director or Chief Pharmacist determines such a rejection to be in the best interest of the

Government.

Second, each of those Contracted Pharmacists and Pharmacy Technicians will need to contact the Service

Unit Human Resource Staff Coordinator to make fingerprinting arrangements.

Contractor’s employees are not able to work a scheduled shift until the security check is performed and clearance has been obtained by the appropriate agency. At a minimum, fingerprints are required and upon clearance a contractor may work a scheduled shift. However, contractors are required to complete the detail

P a g e | 8 background application and application is to be completed within 30 days once the contractor’s employee has been given access.

All Contractors’ are subject to criminal background check prior to performing services in accordance with the contract terms and conditions. The contractor shall ensure that each of their provider complete the, Certification of Criminal History and Background Check Packet. The completed forms are to be returned to the Project Officer. Additional Background Check packets can be obtained through the Project Officer.

Contractors (and their employees) requiring routine, long-term access (i.e., greater than 6 months) to IHS facilities and/or systems; or providing services to children under 18 year of age are subject to criminal background checks prior to performing services. The contractor shall ensure that each employee(s) complete the Certification of Criminal History and Background Check Packets to initiate the Child & Youth Services

National Agency Check with Inquiries (CNACI). The PO is responsible for providing the contractor with all necessary background check forms. The PO is also responsible for ensuring all background check forms are fully completed and processed prior to commencement of service. The contractor shall return all completed forms to the Service Unit Human Resource Office. Contractors may be directed to the e-QIP website to complete the necessary background investigation forms online (inquire with the Service Unit HR should you wish to complete forms electronically). All contractors (or their employees) must appear in person to IHS (or an IHS facility) with two acceptable forms of identity; fingerprints will be taken electronically, or on paper, at this time. This must occur prior to the first date of service (realistically allow a 14 to 30-day processing time before the actual start date). At a minimum, if results are not received within 5 days, the identity credentials can be issued based on a favorable FBI National Criminal History Check (fingerprint check). Note: These timeframes are based on complete and acceptable package, including legible fingerprints.

FOR MORE INFORMATION ON SECURITY REQUIREMENTS PLEASE REFER TO DHHS SITE:

http://intranet.hhs.gov/pivcard/brochure.html

DELIVERABLES:

The Contractor is required to provide a copy of each Contractor’s employee profile to the Contracting Officer Representative (or service unit representative(s)) prior to providing services at SERVICE UNITS.

Timesheet shall be submitted to the supervisor of the respective department to which the Contractor’s employee(s) is assigned to work or his/her designee. The timesheets shall be reviewed for accuracy and certified by signature as accurate and acceptable for payment, then forwarded to the receiving official for further processing of receipt of services through US Treasury utilizing IPP.

CONTRACTING OFFICER REPRESENTATIVE (COR) RESPONSIBILITIES:

The Contracting Officer will designate in writing a COR who shall be responsible for:

1. Monitoring the Contractor’s technical progress, including the surveillance and assessment of performance and recommending to the Contracting Officer, changes in requirements

2. Interpreting scope of work

3. Performing technical evaluations required

4. Performing technical inspections and acceptances required by this contract

5. Monitoring funds available for obligation under this contract

6. The resolution of technical problems encountered during performance of this contract

In no event is the COR empowered to change any of the terms and conditions of the contract. Changes in the scope of work, contract price, quantity, and quality or delivery schedule shall be made only by the Contracting

Officer by a properly exercised modification.

http://intranet.hhs.gov/pivcard/brochure.html

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The designation of a COR does not authorize or provide a legal right to change any kind of contractual terms regardless of the Contractor’s apparent difficulties in fulfilling contract requirements.

CONTRACTING OFFICER (CO) RESPONSIBILITIES:

The Contracting Officer is the only person delegated the authority to negotiate changes in terms, conditions, or amounts cited in this contract.

PERFORMANCE CONDITIONS:

The COR (or service unit representative(s)) will submit schedules of required coverage a minimum of 15 calendar days prior to the first day of coverage requested.

In the event the Contractor’s employee is unable to render service on a previously agreed schedule, the Contractor shall provide a minimum seventy-two (72) hour notification to the COR and service unit representative(s). The Contractor shall then make a full, good-faith effort to provide coverage with a replacement.

Both parties recognize that on occasion there shall be a need to fill coverage requests with less than a 15- day notice. In such an emergency scheduling situation, the Contractor shall make a full, good-faith effort to accommodate the emergency request. If the Contractor is unable to meet the emergency scheduling request, they shall immediately notify the COR and service unit representative(s).

3. Service Unit Representatives: TBD at time of award

ADDENDUM:

1. Pro-Children Act of 1994

The Contractor certifies that it will comply with the provisions of Public Law 103-227, Pro- Children Act of 1994 which imposes restrictions on smoking where federally funded children’s services are provided.

The Act requires that smoking should be prohibited in any indoor facility owned, leased, or contracted for or used for the routine or regular provision of health care, day care, or early childhood development (Head Start) services to children under the age of 18. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 per violation and/or the imposition of an administrative compliance order on the responsible entity. By submitting an offer and entering into a contractual agreement with the Government, Contractors certify that they will comply with the requirements of the Act.

Contractors must obtain the same certification from subcontractors.

2. P.L. 101-630, The Indian Child Protection and Family Violence Prevention Act

Contractors whose duties and responsibilities involve regular contact or control over children are subject to a character investigation as required by Public Law 101-630, The Indian Child Protection and Family Violence Act. IHS will conduct these investigations following award of a contract. The character investigation may be waived if, in the judgment of the Contracting Officer, in consultation with the

Personnel Officer, an investigation has already been conducted and is on file. Until the character investigation has been completed and the Contracting Officer notified of the results, the Contractor must not have unsupervised contact with Indian children.

3. Department of Health and Human Services Tobacco Policy

The Contractor’s employee shall comply with the Department of Health & Human Services Tobacco- Free Policy (copy available upon request). Contractor’s employee shall not use tobacco products of any kind (e.g., cigarettes, cigars, pipes, and smokeless tobacco) while on any HHS Property- owned or

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4. Indian Child Protection and Family Violence Prevention Act

No performance under this contract will be allowed without full compliance with the Indian child protection and family violence prevention act, Public Law 101-630 and the Indian Health Service memo dated February 3, 1997, investigations on child care workers. Contractor shall ensure that proposed providers cooperate with and assist the government in the conduction of any necessary background checks.

5. Crime Control Act of 1990

No performance under this contract will be allowed without full compliance with the crime control act of

1990, Public Law 101-647 and the Indian Health Service memo dated February 3, 1997, investigations on child care workers. Contractor shall ensure that proposed providers cooperate with and assist the government in the conduction of any necessary background checks.

Invoice Submission and Payment:

1. GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be submitted electronically via IPP (Invoice Processing Platform).

INVOICING/BILLING:

Contractor shall establish a recordkeeping system of contractor services provided. Contractor may only bill for lease or purchase of equipment and support service provided to PIMC. At the end of each month, the contractor will submit an invoice for payment.

Invoice Requirements and Supporting Documentation: Supporting documentation and invoices must be submitted no later than the 30th workday of the month after services have been provided.

Changes or corrections shall be submitted by separate invoice. In addition to information required for submission of a “proper” invoice in accordance with FAR 52.212-4 (g) all invoices must include:

1. Invoice Date and Number

2. Contract Number

3. Charges for service or products identified BY LINE ITEM Number

4. Brief description of products or services rendered

5. Charges should follow Line Item structure on contract to include Quantity, Unit of Issue, Unit Price, and

Total Amount as applicable

6. Dates of Service or Shipment

Invoices shall be prepared and submitted electronically and in accordance with rates and terms as stated in the contract. Invoices shall be submitted electronically in IPP through the US Treasury. Notification and a copy of the Invoice shall be submitted to:

1. Acquisitions: Michele.Lodge@ihs.gov, a copy of the invoice should be sent electronically to the contract specialist(s) at the address listed above.

2. Service Unit Representatives: _TBD______ and __TBD_____________ A copy of the invoice should be sent electronically to the Service Unit Representative(s) at the address listed above.

PERFORMANCE BASED ASSESSMENT:

(a) Introduction – Performance Requirements:

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(1) A Quality Assurance Surveillance Plan (QASP) has been developed for in-house operations or to implement a service contract. It is designed to aid the PO in providing effective and systematic surveillance of all aspects of professional nursing services. This plan provides for monitoring the contract requirements

(b) The objective of this surveillance plan is to evaluate how the Contractor is performing in key areas. The government is primarily interested in the final service being provided and not in the details of accomplishment.

(c) The principal method of surveillance will be daily in some cases or by use or periodic inspections. Appropriate indicators are provided for recording observations in this type of surveillance.

(d) How to Use the Performance Based Matrix

(i) Each defect observed will be recorded on the tally report. These documents will then become a formal record for later reference. The tally of defects at the end of each clinic or year (dependent on criteria) will be compared to the acceptable number of defects appearing in the surveillance plan. Errors detected by the PO in the course of surveillance will be transmitted to the Contractor or in-house personnel for correction. Notification of errors will take place within five (5) working days. Specifics concerning any errors should be recorded on the tally checklist. The Contractor or in-house personnel, as applicable, should be asked to initial this record.

(ii) Project Officer shall forward a copy of Contractor’s compliance with performance and non- performance compliance reports.

(e) Quality Assurance Surveillance Plan (QASP):

(i) The Government shall monitor the Contractors’ performance through a Quality

Assurance Surveillance Plan (QASP). The QASP is for informational purposes only and not considered part of the contract.

(ii) Surveillance systems will include periodic inspection and acceptance of all Deliverables as cited in the contract.

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PERFORMANCE-BASED MATRIX

Outcome Required

Services

AQL

Standard

Max Allowable

Degree of

Deviation from

Requirement/

(AQL)

Normal Method of

Surveillance

Incentives and Deduction from

Contract Price

Pharmacy

Personnel

Non-Personal

Services

Contract

Minimum

Qualification for

Pharmacy services

Contractor shall submit supporting documentation for approval

100% Compliant Government review of contractor’s documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation no award, Pharmacy

Personnel

Non-Personal

Services

Contract

Licensure for Pharmacy

Services

Contractor shall submit supporting documentation of licensure;

Licensure shall be in good standing

100% Compliant Government review of contractor’s documentation for compliance

Incentive: Government approves documentation

De-incentive: Government rejects documentation, payment may be withheld

Pharmacy

Personnel

Non-Personal

Services

Contract

Background

Investigation in compliance with

Indian Child

Protection and Family

Violence Prevention

Act, Public Law 101-

Contractor shall submit supporting documentation f o r b ackground investigation

100% Compliant Government review of contractor’s documentation for compliance

Incentive: Government approves documentation

De-incentive: Government rejects documentation no award, Pharmacy Personnel

Non-Personal

Services

Contract

Immunization

Compliance

Contractor shall submit supporting documentation of immunization compliance

100% Compliant Government review of contractor’s documentation for compliance

Incentive: Government approves documentation

De-incentive: Government reject documentation no award

Unacceptable Performance

In the event of unacceptable performance, lack of professionalism, unacceptable conduct, the Contractor shall replace personnel

Contractor shall replace personnel within (7) days upon receipt of written notification

90% Compliant Government shall notify the contractor in writing of non-compliance

Incentive: No interruption of performance and positive evaluation documented in governments’ database.

De-incentive: Two (2) occurrences of which the contractor is unable to replace personnel within the time allowance, a cure notice shall be issued and possible termination of contract. Evaluation documenting performance in the national IHS database.

Long-term shifts fulfilled

(Thirteen (13) week travelers)

Filled long-term work shifts as scheduled by the Service Unit. Long

Term shifts contractor personnel shall provide at least a 4 week notice so that the position can be filled prior to vacancy.

Contractor shall ensure full shift coverage for long term pharmacy needs at the

Service Unit

100% Government’s review

& written documentation/ notification to

Contractor of non-compliance.

Incentive: No disruption of performance; positive evaluation documented in government’s database.

De-incentive: Two notices to the contractor, a cure notice shall be issued and possible termination of contract. Evaluation documented in national IHS database.

Short-term shifts fulfilled

(Immediate staffing needs)

Filled short-term work shifts as scheduled by the Service Unit.

Contractor shall ensure full shift coverage for short- term needs at the

Service unit

85% Same as above Same as above

END OF STATEMENT OF WORK