HomeMy WebLinkAbout2017-263-E Health - Robert Dupuis for pharmacy services DocuSign Envelope ID:90CC09F4-5057-4B 1 F-AC03-CF23967BA7A0
[Departmental Use Only]
TITLE Pharmacy Services
FY 2017-2018
ORANGE COUNTY
CONTRACT UNDER $25,000.00
NORTH CAROLINA
THIS AGREEMENT, made and entered into this 1st day of June, 2017, ("Effective Date") by and
between Orange County, North Carolina, a body politic and corporate organized under the laws of the State
of North Carolina, (the "County"), party of the first part; and Robert E. Dupuis (the "Provider"), party of the
second part;
WITNESSETH:
For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby
contracts for the services of the Provider, and the Provider agrees to provide the following services to the
County in accordance with the terms of this Agreement, time being of the essence:
The term of this agreement shall be from July 1, 2017 to June 30, 2018.
Provider represents and agrees that Provider is qualified to perform and fully capable of performing and
providing the services required or necessary under this Agreement in a fully competent, professional and
timely manner to the satisfaction of the County. Provider shall be responsible for all errors or omissions, in
the performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies,
ambiguities,mistakes or conflicts at no additional cost to the County. Provider agrees that Provider shall not
sub-contract any of the services to be provided in this Agreement, nor shall Provider assign any right or
responsibility granted or required by this Agreement, without the prior written approval of the County.
SPECIFIC TERMS
1. Scope of Services. The services and/or materials (hereinafter referred to collectively as
"Services") to be furnished under this Agreement are as follows:
A. Provider.
1) Scope of Work. Direct Pharmacy Services at the two pharmacy sites of the Health
Department as provided in Attachment A, Scope of Work.
2) Confidentiality. The Contractor agrees to sign the OCHD Personal Health
Services Division Confidentiality Agreement and Business Associate
Agreement, and agrees to maintain confidentiality per these Agreements. The
Contractor will comply with such confidentiality laws as may be applicable
in the performance of these agreements and acknowledges that in receiving,
storing, processing or otherwise dealing with any confidential information,
Contractor will safeguard and not further disclose the information except as
permitted by the Health Insurance Portability and Accountability Act of
1996, Public Law 104-191, as amended.
3) Licensure. The Contractor agrees to maintain North Carolina Pharmacy License and
to present proof of such license.
B. Orange County Health Department.
Revised 6/16 1
DocuSign Envelope ID:90CC09F4-5057-4B 1 F-AC03-CF23967BA7A0
1) Designate a nursing supervisor to provide guidance and assistance with related
administrative or technical aspects of providing pharmacy services at Health
Department sites as requested.
2) Participate in the ongoing evaluation of the role of the pharmacist and provide an
annual evaluation of pharmacist's performance of contract.
3) Enable the pharmacist to perform all activities mandated by laws, regulations and
standards.
4) Obtain required pharmacy licenses for all sites.
5) Allow the pharmacist to participate in other related activities in the Health
Department as agreed to by both parties
6) Comply with such non-discrimination laws and/or employment practices as may be
applicable in fulfilling this contract.
2. Payment: The County agrees to pay at the rates specified for Services satisfactorily performed in
accord with this Agreement. The amount to be paid by the County shall not exceed Twelve Thousand Six
Hundred Forty Five dollars, ($12,645). Payment shall be made in twelve (12) equal installments of One
Thousand Fifty-Three and 75/100 dollars ($1,053.75) within thirty (30) days of an invoice properly
submitted to County. Should Provider fail to perform its duties under the terms of this Agreement, County
may, without fault or penalty, withhold any payment associated with the work to be performed until such
time as said work is completed.
3. Non—waiver: Failure by County at any time to require the performance by Provider of any
of the provisions hereof shall in no way waive or affect the County's right hereunder to enforce the same, nor
shall any waiver by the County of any breach be held to be a waiver of any succeeding breach or a waiver of
this Non-Waiver Clause.
4. Independent Contractor: The Provider shall operate as an independent Provider, and the
County shall not be responsible for any of the Provider's acts or omissions. The Provider shall not be treated
as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or
workers' compensation purposes. The Provider understands that neither federal, nor state, nor payroll tax of
any kind shall be withheld or paid by the County on behalf of the Provider or the employees of the Provider.
The Provider understands that no benefits, including Worker's Compensation coverage, will be provided to
him by the County.
5. Insurance.
A. General Requirements. The Provider shall purchase and maintain during the
period of performance of this Agreement Professional Liability Insurance,
covering personal injury, bodily injury and property damage and claims arising
out of or related to the performance under this Agreement by the Provider.
B. Limits of Coverage. The Provider shall maintain professional liability insurance
coverage with coverage of at least $1 million, per occurrence, $3 million
aggregate while providing services to the County.
C. Evidence of Insurance. Evidence of such insurance shall be furnished to the
County, together with evidence that each policy provides the County with not
less than thirty (30) days prior written notice of any cancellation, non-renewal or
reduction of coverage.
Revised 6/16 2
DocuSign Envelope ID:90CC09F4-5057-4B 1 F-AC03-CF23967BA7A0
6. Indemnity: The Provider agrees to defend, indemnify, and hold harmless Orange County
from all losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable
attorney's fees) arising from bodily injury, including death, to any person or persons or damage to or
destruction of any property caused in whole or in part by any negligent or intentional act or omission on the
part of the Provider.
7. Termination: This Agreement may be terminated at any time without cause by either Party
upon sixty(60) days written notice. This agreement may be terminated with cause at any time by either
party upon at least 30 days prior written notice to the other party upon default of one or more of its
obligations hereunder,unless such default is cured within 30 days of the notice of termination.
8. Entire Agreement: The parties have read this Agreement and agree to be bound by all of its
terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between
the parties unless and until modified in writing and signed by the parties. Modifications may be evidenced
by telefacsimile signature.
9. Governing Law: Both parties agree that this Agreement shall be governed by the laws of the
State of North Carolina. Provider shall at all times remain in compliance with all applicable local, state, and
federal laws,rules, and regulations including but not limited to all state and federal anti-discrimination laws,
policies, rules, and regulations and the Orange County Anti-Discrimination Policy. Any violation of this
requirement is a breach of this Agreement and County may immediately terminate this Agreement without
further obligation on the part of the County. This paragraph is not intended to limit and does not limit the
definition of breach to discrimination. By executing this Agreement Provider affirms that Provider is and
shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By
executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the
services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58.
10. Non Appropriation: Provider acknowledges that County is a governmental entity, and the
validity of this Agreement is based upon the availability of public funding under the authority of its statutory
mandate. In the event that public funds are unavailable and not appropriated for the performance of County's
obligations under this Agreement, then this Agreement shall automatically expire without penalty to County
immediately upon written notice to Provider of the unavailability and non-appropriation of public funds.
11. Signature: This Agreement together with any amendments or modifications may be
executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply
with Article 1 1 A and Article 40 of North Carolina General Statute Chapter 66.
12. Priority: In determining the basic services to be provided, should any documents be
referenced in this Agreement, the terms herein shall have priority in any conflict between the terms
of referenced documents and the terms of this Agreement, except the Business Associate
Agreement.
IN WITNESS WHEREOF,Orange County and the Provider have signed this Agreement, effective
as of the day first written above.
OR GE'+S tNTY PR Hdred by:
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By: 0637994B755E477... BY: aoaFRRSeaEnoaaa
Bonnie Hammersley., County Manager Robert E. Dupuis,Pharm.D, BCPS
200 S. Cameron St. 205 Kenilworth Place
P.O. Box 8181 Chapel Hill NC, 27516
Hillsborough,NC 27278
Revised 6/16 3
DocuSign Envelope ID:90CC09F4-5057-4B 1 F-AC03-CF23967BA7A0
Attachment A- Pharmacy Contract July 1, 2017—June 30, 2018
PHARMACY SERVICES
Scope of Work
Scope of Services for the Agreement between Robert E. Dupuis and Orange County by and
through the Orange County Health Department for Pharmacy Services effective, July 1, 2017 and
shall terminate on June 30, 2018. It is understood that the Contractor will provide direct
pharmacy services at the two pharmacy sites of the Health Department.
I. The Contractor to provide the following Services:
A. Administrative Duties
1. Assist in the development of written policies and procedures for legal,
safe and effective drug therapy, distribution, control and use.
2. Work with the Department pharmacy nurse in:
a. Developing and maintaining a formulary
b. Evaluating and improving procedures for drug procurement,
storage, packaging and labeling
3. Work with the Department Assurance Nurse in the Medication Assistance
Program (MAP) in:
a. Verifying correct drug and dosage sent by drug companies
b. Splitting drugs as requested by clinician
c. Labeling drugs
d. Notifying Assurance Nurse when drugs are ready for dispensing
4. Oversee all activities related to the operation of the pharmacies at the
Hillsborough Whitted Center and Chapel Hill Southern Human Services
Center.
5. Prepare and submit a quarterly report reviewing pharmacy activities and
related issues.
6. Prepare and submit an annual report summarizing pharmacy activities
and accomplishments for the current year and goals/plans for the next
year.
7. Assist the Clinical Services Nursing Supervisor in budget preparation for
pharmaceuticals and related supplies, when requested.
8. Assist the Clinical Services Nursing Supervisor in acquiring
pharmaceuticals in a cost-efficient manner.
9. Evaluate and improve therapeutics within the Health Department.
10. Provide pharmacy training for new public health nurses and nurse
practitioners.
DocuSign Envelope ID:90CC09F4-5057-4B 1 F-AC03-CF23967BA7A0
Attachment A- Pharmacy Contract July 1, 2017—June 30, 2018
11. Evaluate pharmaceutical software for Health Department pharmacy
functions as requested by the Division Director.
12. To the extent the Contractor keeps records, the Contractor agrees to
make all such records available to the Department for auditing, reporting
or any other purpose deemed necessary by the Department.
B. Drug Distribution:
1. Prepack stock formulary pharmaceuticals adhering to pharmacy law
requirements and ensuring maintenance of adequate prepacked
supplies.
2. Label medications received through the Medication Assistance Program
(MAP).
3. Review dispensing logs at all Health Department sites weekly.
4. Review dispensing logs within 24 hours when more than 30 prescriptions
have been distributed.
5. Maintain the drug distribution system in compliance with all laws,
regulations and standards.
6. Provide drug information on an on-call basis when needed by staff.
7. Assist with the development and/or the procurement of necessary drug
information/patient education materials to include information in
languages other than English when needed.
8. Be available to directly dispense medications not approved for public
health nurse dispensing in times of communicable disease outbreaks.
9. Review at least 3 clinical charts from each site monthly, comparing them
to the dispensing log for accuracy and completeness. Document
findings in the "OCHD Pharmacy Quality Assurance Indicator, Chart
Review" log.
10. Complete pharmacy incident report on all errors and forward to the
Clinical Nursing Supervisor for development of corrective actions.
11. Comply with such non-discrimination laws and/or employment practices
as may be applicable in fulfilling this contract.
DocuSign Envelope ID:90CC09F4-5057-4B 1 F-AC03-CF23967BA7A0
S
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Healthcare Professional Liability
LIBERTY INSURANCE UNDERWRITERS INC.
(A Stock Insurance Company,hereinafter the Company)
55 Water Street, 18th Floor
New York,NY 10041
DECLARATIONS
Policy Number: AHY-768247003 Renewal Of: AHY-768247002
SECTION I
Item
1. Named Insured: Robert E. Dupuis
2. Mailing Address: c/o NCAIA,
PO Box 1165
Cary, NC 27512
3. Policy Period: From: 12/22/2016 To: 12/22/2017
12:01 A. M. Standard Time At Location of Designated Premises
4. Business or Profession: Affiliation: 3452-American Soc. of Health Sys. Pharmacists
Pharmacist
5. The Named Insured is a(n): Partnership ❑Corporation ®Individual ❑LLC
USole Proprietor (with employees) ❑Professional Association❑Other
This policy is made and accepted subject to the printed conditions of this policy together with the provisions, stipulations
and agreements contained in the following form(s) or endorsements(s): HCPL-20371(01/14),HCPL-2038(11/09),HCPL-8101A(04114)
HCPL-2037-9000-NC (11/09)OFAC (08/09)
HCPL-8103(05/15),
HCPL-8320(01/15),HCPL-8321(01115),HCPL-8324(01/15),HCPL-8328(02/15)
SECTION II
Item COVERAGE Premium
A. Professional Liability I X1 $105.00
B. General Liability I I
Terrorism Risk Insurance Act [ ]
C. Endorsements [X] $25.00
U. Risk Purchasing Group Fee $0.00
TOTAL: $130.00
LIMITS OF LIABILITY
$2,000,000 Each Incident and Each Occurrence $4,000,000 Aggregate
SECTION III
SUPPLEMENTARY PAYMENTS
A. First Party Assault
B. Licensing Board Reimbursement
C. Wage Loss and Expense
D. Deposition Expense
E. First Aid Reimbursement
Representative Agent: Mercer Consumer,a service of
Mercer Health&Benefits Administration LLC
P.U.Box 14576
1 El Des Moines,IA 50306-3576
HCPL-2037D (11/09)
DocuSign Envelope ID:90CC09F4-5057-4B 1 F-AC03-CF23967BA7A0
Client# 484672
MEMORANDUM OF INSURANCE Date Issued 11/11/2016
Producer This memorandum is issued as a matter of information
only and confers no rights upon the holder. This
Mercer Consumer, a service of memorandum does not amend, extend or alter—the-
Mercer Health & Benefits Administration LLC coverages afforded by the Certificate listed below.
P.O. Box 14576
Des Moines, IA 50306-3576
1-800-503-9230 Company Affording Coverage
Insured Liberty Insurance Underwriters Inc
North Carolina Assoc of Ins Agents Inc
Robert E. Dupuis 101 Weston Oaks Court
c/o NCAIA Cary NC 27513
PO Box 1165
Cary NC 27512
This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicated,
not withstanding any requirement, term or condition of any contract or other document with respect to which this
memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the
terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims.
Type of Insurance Certificate Number Effective Date Expiration Date Limits
Professional Liability AHY-768247003 12/22/2016 12/22/2017 Per Incident/ $2,000,000
Pharmacist E Occurrence
Pharmacist
Annual Aggregate $4,000,000
PROOF OF INSURANCE
Memorandum Holder: Should the above describe Certificate be cancelled
before the expiration date thereof, the issuing company
PROOF OF COVERAGE ONLY will endeavor to mail 30 days written notice to the
Memorandum Holder named to the left, but failure to
mail such notice shall impose no obligation or liability
of any kind upon the company, its agents or
representatives.
Authorized Representative
Mark Brostowitz
Of-K _a. 1
Mercer Consumer,a service of Mercer Health &Benefits Administration LLC. In CA d/b/a Mercer Health &Benefits Insurance Services LLC. CA Ins Lic. #0G39709