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HomeMy WebLinkAboutS Personnel - CAREMARK HEALTH & NACo MANAGED PHARMACY BENEFIT SERVICES AGREEMENT FOR MEMBER COUNTYio ~-o ~~ EXHIBIT C CAREMARKPCS HEALTH, L.P. NATIONAL ASSOCIATION OF COUNTIES MANAGED PHARMACY BENEFIT SERVICES AGREEMENT FOR MEMBER COUNTY This Managed Pharmacy Benefit Services Agreement for Member County effective _ , ~AN Gc a2 y ~ •~~~ is entered into by and between CaremazkPCS Health, L.P. ("Caremark") and _ _/72A N ~ ~ oC„~,Trj T!~ C~//tp L/Ipq ("Member County"). Reference is hereby made to the Managed Pharmacy Benefit Services Agreement Consumer Card Program dated as of March 1, 2006 (the "Agreement") among National Association of Counties ("Customer"), Member County, and Caremark under which Customer has engaged Caremark to provide services to prescription drug plans for Customer and its Member Counties. MEMBER COUNTY does hereby agree to be bound by, and to assume and perform, each and all of the terms, covenants and conditions of the Agreement as Member County (as defined in the Agreement) in the same manner and to the same extent as if it were a party thereto. Member County acknowledges and agrees that Customer and Cazemazk may amend all or any portion of the Agreement, except with respect to the Initial Term, and Member County hereby agrees to be bound by any such amendment. Customer shall give Member County reasonable notice prior to the effective date of any such amendment. If such amendment is adverse to Member County or its Participants, Member County may, within ninety (90) days of receiving such notice from Customer, terminate its participation in the Agreement by giving prior written notice to Customer and Cazemazk. Each party certifies that it shall not violate the federal anti-kickback statute, set forth at 42 U.S.C. § 1320a-7b(b) ("Anti- Kickback Statute"), or the federal "Stark Law," set forth at 42 U.S.C. § 1395nn ("Stark Law"), with respect to the performance of its obligations under this Agreement. Further, Cazemazk shall ensure that individuals meeting the definition of "Covered Persons" (as such term is defined in the Corporate Integrity Agreement between the Office of InspectorGen eral of the Depardnent of Health and Human Services and AdvancePCS) shall comply with Cazemazk's Compliance Program, including training related to the Anti-Kickback Statute and the Stark Law. In addition, Cazemark's Code of Conduct and policies and procedures on the Anti-Kickback Statute and Stark Law may be accessed at htt ://www.caremark.com/w s/ ortal/ s.155/3370?cros=CMS-2-007764. Customer and Cazemazk, by their signatures hereto, accept and agree to Member County's participation with the Agreement under the terms and conditions of the Agreement. By signing this Managed Pharmacy Benefit Services Agreement for Member County, Member County acknowledges and agrees that the terms of the Agreement have been completely read, fully understood and voluntazily accepted and further agrees to be bound thereby. NATIONAL ASSOCIA N OF CO TIES By: Title: ,~ /,~,, Date: ~~~ / ~ -~ ~ MEMBER COUNTY: CAREMARKPCS HEALTH, L.P. By: CaremarkPCS Health Systems, LLC, its General Partner By - ~P "~ ~c®z.,J ~-~i 2-/~ -7 , NACo k3-v2.doc (02/24/2006) [RzClaiml Pale 15 of 29 This document contains proprietary mformaGon of Caremark, and may not be used for any purpose other than to evaluate entering into a relationship with Cazemark, nor may it be duplicated or disclosed to others for any purpose. *Thts checklist is not part ojthe NACo contract, however, please return it with your signed contract *Incomplete or incorrect checklists will delay implementation of the program NACo Prescription Drug Program checklist County Name/State: d RAW 6< <0 4•~+T y NG Date contract returned to NACo: 1. Who is the ONE contact person in the county with whom we may communicate about this program? Name and title /V A M O y ~'v SfON ~ / /Z,c CfDiz ~ ,Sp C ~ ,¢ L $~R u t G ~ S Address (w/City, State, Zip) ~ !~ . I~,( ~~ ~ ~ Phone 9 /g Sys a 8'ya Fax Cl/ ~ ~i SI `/ 3yOS E-mail (We must have your a-mail address!) lIOc9TO.y ~° Co . o~~e , /l ~• 4 3 r 2. What is your county's anticipated start-up date for the program? CURRENT START UP TIME IS 8-IO WEEKS FROM THE TIME THE CONTRACT IS RETURNED TO NACo. Please plan your county's roll out of the program accordingly.. q.44 ~s y .Zao ~' 3. Please choose a design for the discount cards: (YOU MUST CIRCLE ONE) a. "County Name" or "County Name)Zx" t~ Logo/seal on cazds a. Be sure to a-mail a black and white logo/seal to agoldschmidt a~aco. org or elandsman a(~aco.org in a jpg or .tiff format b. Put "(COUNTY NAME) LOGO" in the subject line of your a-mail c. Other. You must contact NACo if you do not choose either a or b. 4. How many cards are you requesting? (We are advising 20% to 25% of your county's total population, , on average. Some count~es may need more.) v, GYRO a. What is your county's population? l/ P~ ~~ b. Do you need cards/posters in Spanish? How many? ~ r' 3 /O 5. Please provide a street address for delivery of cazds. Cards will be sent via UPS Ground. NO PO BOXES! .300 lilJC Sf 7R t10~t/ S>•t t FT 6. What is your county's web address (if available)? (tJ ltJ~•l, Co . p errs ~ n c. s Will this program have its own page? (Please provide) ~- ~"Ar/np~~ What number would county residents call to pick up a cazd? g/ f ~S ~~~ ********************************************************************************** This sectiox jor NACo use only Copy of signed contract sent to Caremark? Signed contract back from Caremark? Proofs approved? Notes: N A~~ nw.o~,a~no~cmn~es EXHIBIT C CAREMARKPCS HEALTH, L.P. NATIONAL ASSOCIATION OF COUNTIES MANAGED PHARMACY BENEFIT SERVICES AGREEMENT FOR MEMBER COUNTY This Managed Pharmacy Benefit Services Agreement for Member County effective ,~AN~c.a2 y ~ -Zc~B is entered into by and between CazemazkPCS Health, L.P. ("Caremark") and _ /72A NL'~ o4n~ ~_ Ni,2Tif CAitpri~9.v ("Member County"). Reference is hereby made to the Managed Pharmacy Benefit Services Agreement Consumer Cazd Program dated as of Mazch 1, 2006 (the "Agreement") among National Association of Counties ("Customer"), Member County, and Cazemazk under which Customer has engaged Cazemazk to provide services to prescription drug plans for Customer and its Member Counties. MEMBER COUNTY does hereby agree to be bound by, and to assume and perform, each and all of the terms, covenants and conditions of the Agreement as Member County (as defined in the Agreement) in the same manner and to the same extent as if it were a party thereto. Member County acknowledges and agrees that Customer and Cazemazk may amend all or any portion of the Agreement, except with respect to the Initial Tenn, and Member County hereby agrees to be bound by any such amendment. Customer shall give Member County reasonable notice prior to the effective date of any such amendment. If such amendment is adverse to Member County or its Participants, Member County may, within ninety (90) days of receiving such notice from Customer, terminate its participation in the Agreement by giving prior written notice to Customer and Cazemazk. Each party certifies that it shall not violate the federal anti-kickback statute, set forth at 42 U.S.C. § 1320a-7b(b) ("Anti- Kickback Statute"), or the federal "Stazk Law," set forth at 42 U.S.C. § 1395nn ("Stazk Law"), with respect to the performance of its obligations under this Agreement. Further, Cazemazk shall ensure that individuals meeting the definition of "Covered Persons" (as such term is defined in the Corporate Integrity Agreement between the Office of InspectorGen eral of the Department of Health and Human Services and AdvancePCS) shall comply with Caremazk's Compliance Program, including training related to the Anti-Kickback Statute and the Stazk Law. In addition, Cazemark's Code of Conduct and policies and procedures on the Anti-Kickback Statute and Stazk Law may be accessed at http://www.cazemark.com/wps/nortaU s 155/3370~cros=CMS 2 007764. Customer and Cazemazk, by their signatures hereto, accept and agree to Member County's participation with the Agreement under the terms and conditions of the Agreement. By signing this Managed Pharmacy Benefit Services Agreement for Member County, Member County acknowledges and agrees that the terms of the Agreement have been completely read, fully understood and voluntazily accepted and further agrees to be bound thereby. NATIONAL ASSOCIATION OF COUNTIES By: Title: Date: MEMBER COUNTY: [County *r°--~, By: Title: Date: CAREMARKPCS HEALTH, L.P. By: CaremarkPCS Health Systems, LLC, its General Partner By: Title: Date: NACo k3-v2.doc (02/24/2006) [12zClaiml ~ Pa a 15 of 29 This document contains proprietary information of Caremazk, and may not be used for any purpose other than to evaluate entering into a relationship with Caremark, nor may it be duplicated or disclosed to others for any purpose.