CONTRACT 230144 - AZ PHARMACY.PDF
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Page 1 of 37 CONTRACT PURSUANT TO PH RFP 230144 This Contract is entered into this 1st day of May 2023 by and between Maricopa County (“County”), a political subdivision of the State of Arizona, and Arizona Pharmacy Association, (“Contractor”) for the purchase of services related to Naloxone Pharmacy Distribution Program. 1.0 CONTRACT TERM: 1.1 This Contract is for a term of 20 months, beginning on the 1st day of May 2023 and ending the 31st day of December 2024. 1.2 The County may, at its option and with the agreement of the Contractor, renew the term of this Contract for additional terms up to a maximum of two (2) additional years, (or at the County’s sole discretion, extend the contract on a month-to-month bases for a maximum of six (6) months after expiration). The County shall notify the Contractor in writing of its intent to extend the Contract term at least sixty (60) calendar days prior to the expiration of the original contract term, or any additional term thereafter. 1.3 CONTRACT COMPLETION: The Contractor shall make all reasonable efforts for an orderly transition of its duties and responsibilities to another provider and/or to the County. This may include, but is not limited to, the preparation of a transition plan and cooperation with the County or other providers in the transition. The transition includes the transfer of all records, and other data in the possession, custody or control of Contractor required to be provided to the County either by the terms of this agreement or as a matter of law. The provisions of this clause shall survive the expiration or termination of this agreement. 2.0 PRICE ADJUSTMENTS: Any requests for reasonable price adjustments must be submitted sixty (60) calendar days prior to the Contract expiration date. Requests for adjustment in cost of labor and/or materials must be supported by appropriate documentation. The reasonableness of the request will be determined by comparing the request with the Consumer Price Index or by performing a market survey. If County agrees to the adjusted price terms, County shall issue written approval of the change and provide an updated version of the Contract. The new change shall not be in effect until the date stipulated on the Contract. 3.0 PAYMENTS: 3.1 As consideration for performance of the duties described herein, County shall pay Contractor the sum(s) stated in Exhibit “A.” 3.2 Payment shall be made upon the County’s receipt of a properly completed invoice. 3.3 INVOICES: 3.3.1 The Contractor shall submit one (1) legible copy of their detailed invoice before payment(s) will be made. Incomplete invoices will not be processed. At a minimum, the invoice must provide the following information: Page 2 of 37 • Company name, address, and contact • County bill-to name and contact information • Contract Serial Number and Title • County purchase order number • Invoice number and date • Payment terms • Deliverable description • Total Amount Due 3.3.2 Problems regarding billing or invoicing shall be directed to the Department as listed on the Purchase Order. 3.3.3 Payment shall only be made to the Contractor by Accounts Payable through the Maricopa County Vendor Express Payment Program. This is an Electronic Funds Transfer (EFT) process. After Contract Award the Contractor shall complete the Vendor Registration Form located on the County Department of Finance Vendor Registration Web Site located at https://azdom-vss-ext.hostams.com/PRDVSS2X1/Advantage4 3.3.4 Discounts offered in the contract shall be calculated based on the date a properly completed invoice is received by the County. 3.3.5 EFT payments to the routing and account numbers designated by the Contractor will include the details on the specific invoices that the payment covers. The Contractor is required to discuss remittance delivery capabilities with their designated financial institution for access to those details. 3.4 APPLICABLE TAXES: 3.4.1 Payment of Taxes: The Contractor shall pay all applicable taxes. With respect to any installation labor on items that are not attached to real property performed by Contractor under the terms of this Contract, the installation labor cost and the gross receipts for materials provided shall be listed separately on the Contractor’s invoices. 3.4.2 State and Local Transaction Privilege Taxes: To the extent any State and local transaction privilege taxes apply to sales made under the terms of this Contract it is the responsibility of the seller to collect and remit all applicable taxes to the proper taxing jurisdiction of authority. 3.4.3 Tax Indemnification: Contractor and all subcontractors shall pay all Federal, State, and local taxes applicable to its operation and any persons employed by the Contractor. Contractor shall require all subcontractors to hold Maricopa County harmless from any responsibility for taxes, damages and interest, if applicable, contributions required under Federal, and/or State and local laws and regulations, and any other costs including transaction privilege taxes, unemployment compensation insurance, Social Security, and Worker’s Compensation. 3.5 TAX (SERVICES): No tax shall be invoiced or paid against Contractor’s labor. It is the responsibility of the Contractor to determine any and all applicable taxes. 4.0 AVAILABILITY OF FUNDS: 4.1 The provisions of this Contract relating to payment for services shall become effective when funds assigned for the purpose of compensating the Contractor as herein provided are available to County for disbursement. The County shall be the sole judge and authority in determining the availability of funds under this Contract. County shall keep the Contractor fully informed as to the availability of funds. Page 3 of 37 4.2 If any action is taken by, any State agency, Federal department, or any other agency or instrumentality to suspend, decrease, or terminate its fiscal obligations under, or in connection with, this Contract, County may amend, suspend, decrease, or terminate its obligations under, or in connection with, this Contract. In the event of termination, County shall be liable for payment only for services rendered prior to the effective date of the termination, provided that such services are performed in accordance with the provisions of this Contract. County shall give written notice of the effective date of any suspension, amendment, or termination under this Section, at least ten (10) days in advance. 5.0 DUTIES: 5.1 The Contractor shall perform all duties stated in Exhibit “B”, or as otherwise directed in writing by the Procurement Officer. 6.0 TERMS AND CONDITIONS: 6.1 INDEMNIFICATION: To the fullest extent permitted by law, and to the extent that claims, damages, losses or expenses are not covered and paid by insurance purchased by the Contractor, the Contractor shall defend indemnify and hold harmless the County (as Owner), its agents, representatives, agents, officers, directors, officials, and employees from and against all claims, damages, losses, and expenses (including, but not limited to attorneys' fees, court costs, expert witness fees, and the costs and attorneys' fees for appellate proceedings) arising out of, or alleged to have resulted from the negligent acts, errors, omissions, or mistakes relating to the performance of this Contract. Contractor's duty to defend, indemnify, and hold harmless the County, its agents, representatives, agents, officers, directors, officials, and employees shall arise in connection with any claim, damage, loss, or expense that is attributable to bodily injury, sickness, disease, death or injury to, impairment of, or destruction of tangible property, including loss of use resulting there from, caused by negligent acts, errors, omissions, or mistakes in the performance of this Contract, but only to the extent caused by the negligent acts or omissions of the Contractor, a subcontractor, any one directly or indirectly employed by them, or anyone for whose acts they may be liable, regardless of whether or not such claim, damage, loss, or expense is caused in part by a party indemnified hereunder. The amount and type of insurance coverage requirements set forth herein will in no way be construed as limiting the scope of the indemnity in this paragraph. The scope of this indemnification does not extend to the sole negligence of County. 6.2 INSURANCE: 6.2.1 Contractor, at Contractor’s own expense, shall purchase and maintain the herein stipulated minimum insurance from a company or companies duly licensed by the State of Arizona and possessing a current A.M. Best, Inc. rating of B++. In lieu of State of Arizona licensing, the stipulated insurance may be purchased from a company or companies, which are authorized to do business in the State of Arizona, provided that said insurance companies meet the approval of County. The form of any insurance policies and forms must be acceptable to County. 6.2.2 All insurance required herein shall be maintained in full force and effect until all work or service required to be performed under the terms of the Contract is satisfactorily completed and formally accepted. Failure to do so may, at the sole discretion of County, constitute a material breach of this Contract. 6.2.3 Contractor’s insurance shall be primary insurance as respects County, and any insurance or self-insurance maintained by County shall not contribute to it. Page 4 of 37 6.2.4 Any failure to comply with the claim reporting provisions of the insurance policies or any breach of an insurance policy warranty shall not affect the County’s right to coverage afforded under the insurance policies. 6.2.5 The insurance policies may provide coverage that contains deductibles or self-insured retentions. Such deductible and/or self-insured retentions shall not be applicable with respect to the coverage provided to County under such policies. Contractor shall be solely responsible for the deductible and/or self-insured retention and County, at its option, may require Contractor to secure payment of such deductibles or self-insured retentions by a surety bond or an irrevocable and unconditional letter of credit. 6.2.6 The insurance policies required by this Contract, except Workers’ Compensation and Errors and Omissions, shall name County, its agents, representatives, officers, directors, officials and employees as Additional Insureds. 6.2.7 The policies required hereunder, except Workers’ Compensation and Errors and Omissions, shall contain a waiver of transfer of rights of recovery (subrogation) against County, its agents, representatives, officers, directors, officials and employees for any claims arising out of Contractor’s work or service. 6.2.8 Commercial General Liability: Commercial General Liability insurance and, if necessary, Commercial Umbrella insurance with a limit of not less than $2,000,000 for each occurrence, $4,000,000 Products/Completed Operations Aggregate, and $4,000,000 General Aggregate Limit. The policy shall include coverage for premises liability, bodily injury, broad form property damage, personal injury, products and completed operations and blanket contractual coverage, and shall not contain any provisions which would serve to limit third party action over claims. There shall be no endorsement or modifications of the CGL limiting the scope of coverage for liability arising from explosion, collapse, or underground property damage. 6.2.9 Automobile Liability: Commercial/Business Automobile Liability insurance and, if necessary, Commercial Umbrella insurance with a combined single limit for bodily injury and property damage of not less than $2,000,000 each occurrence with respect to any of the Contractor’s owned, hired, and non-owned vehicles assigned to or used in performance of the Contractor’s work or services or use or maintenance of the premises under this Contract. 6.2.10 Workers’ Compensation: Workers’ Compensation insurance to cover obligations imposed by Federal and State statutes having jurisdiction of Contractor’s employees engaged in the performance of the work or services under this Contract; and Employer’s Liability insurance of not less than $1,000,000 for each accident, $1,000,000 disease for each employee, and $1,000,000 disease policy limit. Contractor, its contractors and its subcontractors waive all rights against Contract and its agents, officers, directors and employees for recovery of damages to the extent these damages are covered by the Workers’ Compensation and Employer’s Liability, or commercial umbrella liability insurance obtained by Contractor, its contractors and its subcontractors pursuant to this Contract. 6.2.11 Certificates of Insurance: 6.2.11.1 Prior to Contract award, Contractor shall furnish the County with valid and complete certificates of insurance, or formal endorsements as required by the Contract in the form provided by the County, issued by Contractor’s insurer(s), as evidence that policies providing the required coverage, conditions and limits Page 5 of 37 required by this Contract are in full force and effect. Such certificates shall identify this contract number and title. 6.2.11.2 In the event any insurance policy(ies) required by this Contract is(are) written on a claims made basis, coverage shall extend for two years past completion and acceptance of Contractor’s work or services and as evidenced by annual Certificates of Insurance. 6.2.11.3 If a policy does expire during the life of the Contract, a renewal certificate must be sent to County fifteen (15) calendar days prior to the expiration date. 6.2.12 Cancellation and Expiration Notice: Applicable to all insurance policies required within the Insurance Requirements of this Contract, Contractor’s insurance shall not be permitted to expire, be suspended, be canceled, or be materially changed for any reason without thirty (30) days prior written notice to Maricopa County. Contractor must provide to Maricopa County, within two (2) business days of receipt, if they receive notice of a policy that has been or will be suspended, canceled, materially changed for any reason, has expired, or will be expiring. Such notice shall be sent directly to Maricopa County Office of Procurement Services and shall be mailed, or hand delivered, to 4041 N. Central Avenue, #1400, Phoenix, AZ 85012 or emailed to the Procurement Officer noted in the solicitation. 6.3 FORCE MAJEURE: 6.3.1 Neither party shall be liable for failure of performance, nor incur any liability to the other party on account of any loss or damage resulting from any delay or failure to perform all or any part of this Contract if such delay or failure is caused by events, occurrences, or causes beyond the reasonable control and without negligence of the parties. Such events, occurrences, or causes will include Acts of God/Nature (including fire, flood, earthquake, storm, hurricane or other natural disaster), war, invasion, act of foreign enemies, hostilities (whether war is declared or not), civil war, riots, rebellion, revolution, insurrection, military or usurped power or confiscation, terrorist activities, nationalization, government sanction, lockout, blockage, embargo, labor dispute, strike, interruption or failure of electricity or telecommunication service. 6.3.2 Each party, as applicable, shall give the other party notice of its inability to perform and particulars in reasonable detail of the cause of the inability. Each party must use best efforts to remedy the situation and remove, as soon as practicable, the cause of its inability to perform or comply. 6.3.3 The party asserting Force Majeure as a cause for non-performance shall have the burden of proving that reasonable steps were taken to minimize delay or damages caused by foreseeable events, that all non-excused obligations were substantially fulfilled, and that the other party was timely notified of the likelihood or actual occurrence which would justify such an assertion, so that other prudent precautions could be contemplated. 6.4 WARRANTY OF SERVICES: 6.4.1 The Contractor warrants that all services provided hereunder will conform to the requirements of the Contract, including all descriptions, specifications and attachments made a part of this Contract. County’s acceptance of services or goods provided by the Contractor shall not relieve the Contractor from its obligations under this warranty. 6.4.2 In addition to its other remedies, County may, at the Contractor's expense, require prompt correction of any services failing to meet the Contractor's warranty herein. Services corrected by the Contractor shall be subject to all the provisions of this Contract in the manner and to the same extent as services originally furnished hereunder. Page 6 of 37 6.5 INSPECTION OF SERVICES: 6.5.1 The Contractor shall provide and maintain an inspection system acceptable to County covering the services under this Contract. Complete records of all inspection work performed by the Contractor shall be maintained and made available to County during Contract performance and for as long afterwards as the Contract requires. 6.5.2 County has the right to inspect and test all services called for by the Contract, to the extent practicable at all times and places during the term of the Contract. County shall perform inspections and tests in a manner that will not unduly delay the work. 6.5.3 If any of the services do not conform to Contract requirements, County may require the Contractor to perform the services again in conformity with Contract requirements, at no cost to the County. When the defects in services cannot be corrected by re-performance, County may: 6.5.3.1 Require the Contractor to take necessary action to ensure that future performance conforms to Contract requirements; and 6.5.3.2 Reduce the Contract price to reflect the reduced value of the services performed. 6.5.4 If the Contractor fails to promptly perform the services again or to take the necessary action to ensure future performance in conformity with Contract requirements, County may: 6.5.4.1 By Contract or otherwise, perform the services and charge to the Contractor, through direct billing or through payment reduction, any cost incurred by County that is directly related to the performance of such service; or 6.5.4.1 Terminate the Contract for default. 6.6 ORDERING AUTHORITY: Any request for purchase shall be accompanied by a valid purchase order, issued by Office of Procurement Services, a Purchase Order issued by the using Department or direction by a Certified Agency Procurement Aid (CAPA) with a Purchase Card for payment. 6.7 NO MINIMUM OR MAXIMUM PURCHASE OBLIGATION: 6.7.1 This Contract does not guarantee any minimum or maximum purchases will be made. Orders will only be placed under this Contract when the County identifies a need and proper authorization and documentation have been approved. 6.7.2 Contractors agree to accept verbal notification of cancellation of Purchase Orders from the County Procurement Officer with written notification to follow. Contractor specifically acknowledges to be bound by this cancellation policy. 6.8 PURCHASE ORDERS: County reserves the right to cancel Purchase Orders within a reasonable period of time after issuance. Should a Purchase Order be canceled, the County agrees to reimburse the Contractor for actual and documentable costs incurred by the Contractor in response to the Purchase Order. The County will not reimburse the Contractor for any costs incurred after receipt of County notice of cancellation, or for lost profits, shipment of product prior to issuance of Purchase Order, etc. 6.9 SUSPENSION OF WORK: The Procurement Officer may order the Contractor, in writing, to suspend, delay, or interrupt all or any part of the work of this contract for the period of time that the Procurement Officer determines appropriate for the convenience of the County. No adjustment shall be made under this clause for Page 7 of 37 any suspension, delay, or interruption to the extent that performance would have been so suspended, delayed, or interrupted by any other cause, including the fault or negligence of the Contractor. No request for adjustment under this clause shall be granted unless the claim, in an amount stated, is asserted in writing as soon as practicable after the termination of the suspension, delay, or interruption, but not later than the date of final payment under the Contract. 6.10 STOP WORK ORDER: The Procurement Officer may, at any time, by written order to the Contractor, require the Contractor to stop all, or any part, of the work called for by this contract for a period of ninety (90) calendar days after the order is delivered to the Contractor, and for any further period to which the parties may agree. The order shall be specifically identified as a stop work order issued under this clause. Upon receipt of the order, the Contractor shall immediately comply with its terms and take all reasonable steps to minimize the incurrence of costs allocable to the work covered by the order during the period of work stoppage. Within a period of 90 calendar days after a stop-work is delivered to the Contractor, or within any extension of that period to which the parties shall have agreed, the Procurement Officer shall either: 6.10.1 Cancel the stop work order; or 6.10.2 Terminate the work covered by the order as provided in the Default, or the Termination for Convenience clause of this Contract. 6.10.3 The Procurement Officer may make an equitable adjustment in the delivery schedule and/or Contract price, or otherwise, and the Contract shall be modified, in writing, accordingly, if the Contractor demonstrates that the stop work order resulted in an increase in costs to the Contractor. 6.11 TERMINATION FOR CONVENIENCE: Maricopa County may terminate the Contract for convenience by providing sixty (60) calendar days advance notice to the Contractor. 6.12 TERMINATION FOR DEFAULT: The County may, by written notice of default to the Contractor, terminate this Contract in whole or in part if the Contractor fails to: 6.12.1 Deliver the supplies or to perform the services within the time specified in this Contract or any extension; 6.12.2 Make progress, so as to endanger performance of this Contract; or 6.12.3 Perform any of the other provisions of this Contract. The County’s right to terminate this contract under these subparagraphs may be exercised if the Contractor does not cure such failure within ten (10) business days (or more if authorized in writing by the County) after receipt of the notice from the Procurement Officer specifying the failure. 6.13 STATUTORY RIGHT OF CANCELLATION FOR CONFLICT OF INTEREST: Notice is given that pursuant to A.R.S. § 38-511 the County may cancel any Contract without penalty or further obligation within three years after execution of the Contract, if any person significantly involved in initiating, negotiating, securing, drafting or creating the Contract on behalf of the County is at any time while the Contract or any extension of the Contract is in effect, an employee or agent of any other party to the Contract in any capacity or consultant to any other party of the Contract with respect to the subject matter of the Contract. Additionally, pursuant to A.R.S § 38-511 the County may recoup any fee or commission paid or due to any person significantly Page 8 of 37 involved in initiating, negotiating, securing, drafting or creating the Contract on behalf of the County from any other party to the Contract arising as the result of the Contract. 6.14 WRITTEN CERTIFICATION PURSUANT to A.R.S. § 35-393.01: If Contractor engages in for-profit activity and has 10 or more employees, and if this agreement has a value of $100,000 or more, Contractor certifies it is not currently engaged in, and agrees for the duration of this agreement to not engage in, a boycott of goods or services from Israel. This certification does not apply to a boycott prohibited by 50 U.S.C. § 4842 or a regulation issued pursuant to 50 U.S.C. § 4842. 6.15 WRITTEN CERTIFICATION PURSUANT to A.R.S. § 35-394: Contractor warrants and certifies that it does not currently, and agrees for the duration of the Agreement, that it will not use: 1. the forced labor of ethnic Uyghurs in the People's Republic of China, 2. any goods or services produced by the forced labor of ethnic Uyghurs in the People's Republic of China, 3. any contractors, subcontractors or suppliers that use the forced labor or any goods or services produced by the forced labor of ethnic Uyghurs in the People's Republic of China. If Contractor becomes aware during the term of this Agreement that the Contractor is not in compliance with this paragraph, Contractor shall notify the County within five business days after becoming aware of the noncompliance. If the Contractor fails to provide a written certification to the County that the Contractor has remedied the noncompliance within 180 days after notifying the County of its noncompliance, then the agreement terminates, except that if the agreement termination date occurs before the end of the 180-day period, the agreement terminates on the agreement termination date. 6.16 CONTRACTOR LICENSE REQUIREMENT: The Contractor shall procure all permits, insurance, licenses and pay the charges and fees necessary and incidental to the lawful conduct of his/her business, and as necessary complete any required certification requirements, required by any and all governmental or non-governmental entities as mandated to maintain compliance with and in good standing for all permits and/or licenses. The Contractor shall keep fully informed of existing and future trade or industry requirements, Federal, State and Local laws, ordinances, and regulations which in any manner affect the fulfillment of a Contract and shall comply with the same. Contractor shall immediately notify both Office of Procurement Services and the Department of all changes concerning permits, insurance, or licenses. 6.17 SUBCONTRACTING: 6.17.1 The Contractor may not assign to another contractor or subcontract to another party for performance of the terms and conditions hereof without the written consent of the County. All correspondence authorizing subcontracting must reference the Contract Number and identify the job project. 6.17.2 The Subcontractor’s rate for the job shall not exceed that of the Prime Contractor’s rate, as bid in the pricing section, unless the Prime Contractor is willing to absorb any higher rates, or the County has approved the increase. The Subcontractor’s invoice shall be invoiced directly to the Prime Contractor, who in turn shall pass-through the costs to the County, without mark-up. A copy of the Subcontractor’s invoice must accompany the Prime Contractor’s invoice. 6.18 AMENDMENTS: Page 9 of 37 All amendments to this Contract shall be in writing and approved/signed by both parties. The designated Procurement Officer shall be responsible for approving all amendments for Maricopa County. 6.19 ADDITIONS/DELETIONS OF REQUIREMENTS: The County reserves the right to add and/or delete materials and services to a Contract. If a service requirement is deleted, payment to the Contractor will be reduced proportionately to the amount of service reduced in accordance with the bid price. If additional materials or services are required from a Contract, prices for such additions will be negotiated between the Contractor and the County. 6.20 STRICT COMPLIANCE: Acceptance by County of a performance that is not in strict compliance with the terms of the Contract shall not be deemed to be a waiver of strict compliance with respect to all other terms of the Contract. 6.21 VALIDITY: The invalidity, in whole or in part, of any provision of this Contract shall not void or affect the validity of any other provision of the Contract. 6.22 SEVERABILITY: The removal, in whole or in part, of any provision of this Contract shall not void or affect the validity of any other provision of this Contract. 6.23 RIGHTS IN DATA: The County shall have the use of data and reports resulting from a Contract without additional cost or other restriction except as may be established by law or applicable regulation. Each Party shall supply to the other Party, upon request, any available information that is relevant to a Contract and to the performance thereunder. 6.24 NON-DISCRIMINATION: Contractor agrees to comply with all provisions and requirements of Arizona Executive Order 2009- 09 including flow down of all provisions and requirements to any subcontractors. Executive Order 2009-09 supersedes Executive order 99-4 and amends Executive order 75-5 and may be viewed and downloaded at the Arizona State Library Research website (http://azmemory.azlibrary.gov/cdm/singleitem/collection/execorders/id/680/rec/1) which is hereby incorporated into this contract as if set forth in full herein. During the performance of this Contract, Contractor shall not discriminate against any employee, client, or any other individual in any way because of that person’s age, race, creed, color, religion, sex, disability, or national origin. 6.25 CERTIFICATION REGARDING DEBARMENT AND SUSPENSION: 6.25.1 The undersigned (authorized official signing on behalf of the Contractor) certifies to the best of his or her knowledge and belief that the Contractor, it’s current officers and directors; 6.25.1.1 are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from being awarded any contract or grant by any United States Department or Agency or any state, or local jurisdiction; 6.25.1.2 have not within three (3) year period preceding this Contract; Page 10 of 37 6.25.1.2.1 been convicted of fraud or any criminal offense in connection with obtaining, attempting to obtain, or as the result of performing a government entity (Federal, State or local) transaction or contract; and 6.25.1.2.2 been convicted of violation of any Federal or State antitrust statues or conviction for embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property regarding a government entity transaction or contract; 6.25.1.2.3 are not presently indicted or criminally charged by a government entity (Federal, State or local) with commission of any criminal offenses in connection with obtaining, attempting to obtain, or as the result of performing a government entity public (Federal, State or local) transaction or contract; and are not presently facing any civil charges from any governmental entity regarding obtaining, attempting to obtain, or from performing any governmental entity contract or other transaction; and have not within a three (3) year period preceding this Contract had any public transaction (Federal, State or local) terminated for cause or default. 6.25.1.3 If any of the above circumstances described in the paragraph are applicable to the entity submitting a bid for this requirement, include with your bid an explanation of the matter including any final resolution. 6.25.2 The Contractor shall include, without modification, this clause in all lower tier covered transactions (i.e., transactions with Subcontractors) and in all solicitations for lower tier covered transactions related to this Contract. 6.26 VERIFICATION REGARDING COMPLIANCE WITH A.R.S. §41-4401 AND FEDERAL IMMIGRATION LAWS AND REGULATIONS: 6.26.1 By entering into the Contract, the Contractor warrants compliance with the Immigration and Nationality Act (INA using E-verify) and all other Federal immigration laws and regulations related to the immigration status of its employees and A.R.S. §23-214(A). The Contractor shall obtain statements from its subcontractors certifying compliance and shall furnish the statements to the Procurement Officer upon request. These warranties shall remain in effect through the term of the Contract. The Contractor and its subcontractors shall also maintain Employment Eligibility Verification forms (I-9) as required by the Immigration Reform and Control Act of 1986, as amended from time to time, for all employees performing work under the Contract and verify employee compliance using the E-verify system and shall keep a record of the verification for the duration of the employee’s employment or at least three (3) years, whichever is longer. I-9 forms are available for download at USCIS.GOV. 6.26.2 The County retains the legal right to inspect Contractor and subcontractor employee documents performing work under this Contract to verify compliance with paragraph 6.26.1 of this Section. Contractor and subcontractor shall be given reasonable notice of the County’s intent to inspect and shall make the documents available at the time and date specified. Should the County suspect or find that the Contractor or any of its subcontractors are not in compliance, the County will consider this a material breach of the Contract and may pursue any and all remedies allowed by law, including, but not limited to; suspension of work, termination of the Contract for default, and suspension and/or debarment of the Contractor. All costs necessary to verify compliance are the responsibility of the Contractor. 6.27 INFLUENCE: As prescribed in MC1-1203 of the Maricopa County Procurement Code, any effort to influence an employee or agent to breach the Maricopa County Ethical Code of Conduct or any ethical conduct may be grounds for Disbarment or Suspension under MC1-902. Page 11 of 37 An attempt to influence includes, but is not limited to: 6.27.1 A Person offering or providing a gratuity, gift, tip, present, donation, money, entertainment or educational passes or tickets, or any type of valuable contribution or subsidy, 6.27.2 That is offered or given with the intent to influence a decision, obtain a contract, garner favorable treatment, or gain favorable consideration of any kind. If a Person attempts to influence any employee or agent of Maricopa County, the Chief Procurement Officer, or his designee, reserves the right to seek any remedy provided by the Maricopa County Procurement Code, any remedy in equity or in the law, or any remedy provided by this contract. 6.28 CONTRACTOR EMPLOYEE WHISTLEBLOWER RIGHTS AND REQUIREMENT TO INFORM EMPLOYEES OF WHISTLERBLOWER RIGHTS: 6.28.1 The Parties agree that this Contract and employees working on this Contract will be subject to the whistleblower rights and remedies in the pilot program on Contractor employee whistleblower protections established at 41 U.S.C. § 4712 by section 828 of the National Defense Authorization Act for Fiscal Year 2013 (Pub. L. 112–239) and section 3.908 of the Federal Acquisition Regulation. 6.28.2 Contractor shall inform its employees in writing, in the predominant language of the workforce, of employee whistleblower rights and protections under 41 U.S.C. § 4712, as described in section 3.908 of the Federal Acquisition Regulation. Documentation of such employee notification must be kept on file by Contractor and copies provided to County upon request. 6.28.3 Contractor shall insert the substance of this clause, including this paragraph, in all subcontracts over the simplified acquisition threshold ($150,000 as of September 2013). 6.29 UNIFORM ADMINISTRATIVE REQUIREMENTS: By entering into this Contract, Contractor agrees to comply with all applicable provisions of Title 2, Subtitle A, Chapter II, PART 200—UNIFORM ADMINISTRATIVE REQUIREMENTS, COST PRINCIPLES, AND AUDIT REQUIREMENTS FOR FEDERAL AWARDS contained in Title 2 C.F.R. § 200 et seq. 6.30 ACCESS TO AND RETENTION OF RECORDS FOR THE PURPOSE OF AUDIT AND/OR OTHER REVIEW: 6.30.1 In accordance with section MC1-371 of the Maricopa County Procurement Code the Contractor agrees to retain (physical or digital copies of) all books, records, accounts, statements, reports, files, and other records and back-up documentation relevant to this Contract for six (6) years after final payment or until after the resolution of any audit questions which could be more than six (6) years, whichever is latest. The County, Federal or State auditors and any other persons duly authorized by the Department shall have full access to, and the right to examine, copy and make use of, any and all said materials. 6.30.2 If the Contractor’s books, records, accounts, statements, reports, files, and other records and back-up documentation relevant to this Contract are not sufficient to support and document that requested services were provided, the Contractor shall reimburse Maricopa County for the services not so adequately supported and documented. 6.31 AUDIT DISALLOWANCES: If at any time it is determined by the County that a cost for which payment has been made is a disallowed cost, the County shall notify the Contractor in writing of the disallowance. The course of action to address the disallowance shall be at sole discretion of the County, and may include either an adjustment to future invoices, request for credit, request for a check or a deduction from Page 12 of 37 current invoices submitted by the Contractor equal to the amount of the disallowance, or to require reimbursement forthwith of the disallowed amount by the Contractor by issuing a check payable to Maricopa County. 6.32 OFFSET FOR DAMAGES: In addition to all other remedies at Law or Equity, the County may offset from any money due to the Contractor any amounts Contractor owes to the County for damages resulting from breach or deficiencies in performance of the Contract. 6.33 CONFIDENTIAL INFORMATION: Any information obtained in the course of performing this Contract may include information that is proprietary or confidential to the County. This provision establishes the Contractor’s obligation regarding such information. The Contractor shall establish and maintain procedures and controls that are adequate to assure that no information contained in its records and/or obtained from the County or from others in carrying out its functions (services) under the Contract shall be used by or disclosed by it, its agents, officers, or employees, except as required to efficiently perform duties under the Contract. The Contractor’s procedures and controls at a minimum must be the same procedures and controls it uses to protect its own proprietary or confidential information. If, at any time during the duration of the Contract, the County determines that the procedures and controls in place are not adequate, the Contractor shall institute any new and/or additional measures requested by the County within fifteen (15) calendar days of the written request to do so. Any requests to the Contractor for County proprietary or confidential information shall be referred to the County for review and approval, prior to any dissemination. 6.34 PUBLIC RECORDS: Under Arizona law, all Offers submitted and opened are public records and must be retained by the Records Manager at the Office of Procurement Services. Offers shall be open to public inspection and copying after Contract award and execution, except for such Offers or sections thereof determined to contain proprietary or confidential information by the Office of Procurement Services. If an Offeror believes that information in its Offer or any resulting Contract should not be released in response to a public record request under Arizona law, the Offeror shall indicate the specific information deemed confidential or proprietary and submit a statement with its offer detailing the reasons that the information should not be disclosed. Such reasons shall include the specific harm or prejudice which may arise from disclosure. The Records Manager of the Office of Procurement Services shall determine whether the identified information is confidential pursuant to the Maricopa County Procurement Code. 6.35 PRICES: Contractor warrants those prices extended to County under this Contract are no higher than those paid by any other customer for these or similar services. 6.36 INTEGRATION: This Contract represents the entire and integrated agreement between the parties and supersedes all prior negotiations, proposals, communications, understandings, representations, or agreements, whether oral or written, express or implied. 6.37 RELATIONSHIPS: 6.37.1 In the performance of the services described herein, the Contractor shall act solely as an Independent Contractor or Subrecipient, and nothing herein or implied herein shall at any Page 13 of 37 time be construed as to create the relationship of employer and employee, co-employee, partnership, principal and agent, or joint venture between the County and the Contractor. 6.37.2 For Task Order contracts: The County reserves the right of final approval on proposed staff for all services performed. Also, upon request by the County, the Contractor shall be required to remove any employees working on County projects and substitute personnel based on the discretion of the County within two (2) business days, unless previously approved by the County. 6.38 REQUIREMENTS FOR SUBRECIPIENTS OF FEDERAL FUNDING OF NON-RESEARCH GRANTS AND COOPERATIVE AGREEMENTS: 6.38.1 Notice is hereby given that this contract is a result of funding received by the American Rescue Plan as listed in Exhibit D. 6.38.1.1 The County shall provide reasonable technical assistance to the Contractor to assist in complying with state and federal laws and regulations, and accountability for diligent performance and compliance with the terms and conditions of this Contract and all applicable laws, regulations, and standards. However, this assistance in no way relieves the Contractor of full responsibility and accountability for its actions and performance in compliance with the terms of this Contract. 6.38.2 Contracts must comply with the Reporting standards as presented by the US. Treasury Final Rule and work with Maricopa County to provide compliance information regarding labor certification documentation and keep records of employees funded through American Rescue Plan Act Funds separate and discrete. 6.38.2.1 A Quarterly Reporting Calendar will be provided to the recipient upon execution of contract 6.38.2.2 Programmatic Compliance and Reporting monitoring process is required with the American Rescue Plan Act. 6.38.2.3 Reporting dates and programmatic Quarterly Report deadlines follow the calendar year quarterly cycle. The Quarterly report will be due according to the date provides in the ARPA Reporting Calendar. 6.38.2 Federal Regulations and Policies: 6.38.2.1 Coronavirus State and Local Fiscal Recovery Funds- Final Rule (31 CFR Part 35) https://www.ecfr.gov/current/title-31/subtitle-A/part-35 6.38.2.2 Coronavirus State and Local Fiscal Recovery Funds Guidance on Recipient Compliance and Reporting Responsibilities (General Guidance) 6.38.2.3 Uniform Administrative Requirements, Cost Principles, and Audit Requirement for HHS Awards (45 CFR Part 75) - Part 75—Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards 6.38.2.4 Uniform Administrative Requirements, Cost Principles, and Audit Requirements, Cost Principles, and Audit Requirements for Federal Awards (2 CFR Part 200) – Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards 6.38.2.5 HHS Grants Policies and Regulations - https://www.hhs.gov/grants/grants/grants-policies-regulations/index.html 6.38.2.6 HHS Grants Policy Statement - https://www.hhs.gov/sites/default/files/grants/grants/policies- regulations/hhsgps107.pdf Page 14 of 37 6.38.2.7 HHS Acquisition Regulation (HHSAR) - https://www.hhs.gov/grants/contracts/contract-policies- regulations/hhsar/index.html 6.38.2.8 Coronavirus Disease 2019 (COVID-19) Funds – As a recipient of funds awarded by HHS under one or more Coronavirus funding initiatives, Contractor agrees to: 6.38.2.8.1 As applicable to the award, comply with existing and/or future directives and guidance from HHS regarding control of the spread of COVID-19 6.38.2.8.2 In consultation and coordination with HHS, provide, commensurate with the condition of the individual, COVID-19 patient care regardless of the individual’s home jurisdiction and/or appropriate public health measures (e.g., social distancing, home isolation) 6.38.2.8.3 Assist the United States Government in the implementation and enforcement of federal orders related to quarantine and isolation. 6.38.2.8.4 To the extent applicable, comply with Section 18115 of the CARES Act, with respect to the reporting to the HHS Secretary of results of tests intended to detect SARS–CoV–2 or to diagnose a possible case of COVID–19. 6.38.2.8.5 The CDC has provided recommendations and guidelines to help mitigate and prevent COVID-19 and has identified vaccines and masks as two of the best tools to prevent the spread of COVID-19. The interim final rule and final rule help support recipients in stopping the spread of COVID-19 through these recommendations and guidelines. 6.38.3 Funding Restrictions and Limitations: 6.38.3.1 HHS Policy on Promoting Efficient Spending - https://www.hhs.gov/grants/contracts/contract-policies-regulations/efficient- spending/index.html 6.38.3.2 Federal Restrictions on Lobbying for HHS Financial Assistance Recipients - https://www.hhs.gov/grants/grants/grants-policies-regulations/lobbying- restrictions.html 6.38.3.3 CDC General Terms and Conditions for Non-Research Awards - https://www.cdc.gov/grants/documents/General-Terms-and-Conditions-Non- Research-Awards.pdf 6.38.3.4 None of the funds, materials, property, or services contributed by the County, Contractor, or Subcontractor under the terms of this Contract may be used for any partisan political activities or used to further the election or defeat of any candidate for public office. 6.38.3.5 Telecommunications and video surveillance equipment, including entities owned or controlled by the People’s Republic of China are unallowable costs? (2 C.F.R. 200.471, 2 C.F.R. 200.216) 6.38.3.6 Section 602(c)(2)(A) of the Social Security Act provides that states and territories may not “use the funds … to either directly or indirectly offset a reduction in … net tax revenue … resulting from a change in law, regulation, or administrative interpretation during the covered period that reduces any tax … or delays the imposition of any tax or tax increase.” ? (pg. 314 SLFRF) Page 15 of 37 6.38.3.7 Sections 602(c)(2)(B) and 603(c)(2) prohibit all recipients, except Tribal governments, from using funds for deposit into any pension fund. 6.38.3.8 Use of funds for debt service, to replenish financial reserves, or to satisfy an obligation arising from a judicial settlement are unallowable. 6.38.3.9 Award recipients may not use funds for a program that undermines practices included in the CDC’s guidelines and recommendations for stopping the spread of COVID-19 6.38.3.9.1 This includes but is not limited: 6.38.3.9.1.1 to pay off business fines incurred as a violation of vaccination or safety requirements. 6.38.3.9.1.2 requiring that businesses abstain from requiring mask use or employee vaccination as a condition of receiving SLFRF funds. 6.38.3.9.1.3 self-dealing or violation of ethics rules provided by OMB (Office of Management and Budget Uniform Guidance). 6.38.3.10 Award recipients also required to comply with other federal, state, and local background laws, including environmental laws and federal civil rights and nondiscrimination requirements, which include prohibitions on discrimination on the basis of race, color, national origin, sex, (including sexual orientation and gender identity), religion, disability, or age, or familial status (having children under the age of 18). 6.38.4 Required Disclosures for Federal Awardee Performance and Integrity Information System (FAPIIS) - Consistent with 45 CFR 75.113, Contractor must disclose, in a timely manner in writing to MCDPH and the HHS Office of Inspector General (OIG), all information related to violations of federal criminal law involving fraud, bribery, or gratuity violations potentially affecting this federal award. Disclosures must be sent in writing to the assigned GMS/GMO identified in the NOA and to the HHS OIG at the following address: U.S. Department of Health and Human Services Office of the Inspector General ATTN: Mandatory Grant Disclosures, Intake Coordinator 330 Independence Avenue, SW Cohen Building, Room 5527 Washington, DC 20201 Fax: (202)-205-0604 (Include “Mandatory Grant Disclosures” in subject line) Email: MandatoryGranteeDisclosures@oig.hhs.gov 6.38.5 Acknowledgment of Federal Funding: 6.38.5.1 When issuing statements, press releases, publications, requests for proposal, bid solicitations and other documents -- such as tool-kits, resource guides, websites, and presentations (hereafter “statements”) -- describing the projects or programs funded in whole or in part by the U.S. Department of Health and Human Services (HHS) federal funds, Contractor must clearly state: 1) the percentage and dollar amount of the total costs of the program or project funded with federal money; and 2) the percentage and dollar amount of the total costs of the project or program funded by non-governmental sources. 6.38.5.2 When issuing statements resulting from activities supported by HHS financial assistance, the Contractor must include an acknowledgement of federal assistance using one of the following or a similar statement. The federal award total must reflect total costs (direct and indirect) for all authorized funds (including supplements and carryover) for the total competitive segment up to the time of the public statement. Page 16 of 37 6.38.5.2.1 If the HHS Grant or Cooperative Agreement is NOT funded with other non-governmental sources: “This [project/publication/program/website, etc.] [is/was] supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $XX with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.” 6.38.5.2.2 If the HHS Grant or Cooperative Agreement IS partially funded with other non-governmental sources: “This [project/publication/program/website, etc.] [is/was] supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $XX with XX percentage funded by CDC/HHS and $XX amount and XX percentage funded by non- government source(s). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.” 6.39 OFFSHORE PERFORMANCE OF WORK PROHIBITED: Due to security and identity protection concerns, direct services under this Agreement shall be performed within the borders of the United States. Any services that are described in the specifications or scope of work that directly serve the State of Arizona or its clients and may involve access to secure or sensitive data or personal client data or development or modification of software for the State shall be performed within the borders of the United States. Unless specifically stated otherwise in the specifications, this definition does not apply to indirect or “overhead” services, redundant back-up services, or services that are incidental to the performance of the Agreement. This provision applies to work performed by the Contractor as well as any Subcontractors. 6.40 AGREEMENT REGARDING COMPLIANCE MONITORING/AUDITING: The County shall monitor Contractor’s compliance for fiscal and programmatic performance under the terms and conditions of this Contract and applicable regulations promulgated by the Federal Funding Agency and Maricopa County. An onsite visit for compliance monitoring and compliance review shall be conducted by the County or its grantor agencies (or by both the County and its grantor agencies) a minimum of one time per fiscal year or at any time during the Contractor’s normal business hours, announced and/or unannounced. For auditing purposes, the County shall provide the Contractor with 30-45 days’ advance notice of any proposed onsite visit. The County will be responsible for scheduling and conducting the Onsite Monitoring Visits and for reporting the findings. During an onsite visit(s), Contractor shall make all records and accounts related to work performed or services provided under this Contract available to the County for inspection and copying. The onsite visit shall provide introductions to points of contact for Maricopa County and provide a fiscal year calendar with Compliance and Finance Timeline dates. County may request information for fiscal monitoring/audits per OMB Uniform Guidance 2 C.F.R. §200. Financial compliance monitoring is mandatory and occurs once per month virtually and includes uploading compliance documents related to the compliance testing topic. The selection picks include Budgets & Payroll (timesheets), Inventory Tracking, Procedures & Policies, Agreements & Contracts and Meetings required. The topics may change depending on Compliance Reviews but a minimum of one week notice will be sent in advance with a Checklist Agenda of items to be collected/uploaded to a secure SharePoint Site (access restricted to main POC on Subrecipient Contract and is required for the Compliance Desk Review Monitoring). The Subrecipient or agency will be responsible for compiling and assembling all requested materials, documents, and records to be uploaded to SharePoint Site. The onsite visit will end with a facility tour for a safety compliance check. County’s Compliance Inspector will be in constant Page 17 of 37 communication for any compliance findings that must be corrected. Areas of non-compliance will be summarized, and a timeline will be established to bring the item into compliance. Documentation of compliance must be submitted to the Compliance Inspector as established in the contract. Review of compliance will be conducted by the Compliance Unit in the County. It is the County’s responsibility to manage and monitor subrecipients, including monitoring their performance and compliance with applicable laws and regulations, as well as taking appropriate action when performance and compliance issues arise. 6.40.1 The following documents, records, and information should be readily available for compliance reviews and virtual testing meeting discussion: • General Financial Management • Records & Reports for Grant Expenditures, Match and Payments • Procurement/Contracts/Purchase Orders/Agreements • Time and Effort Reports/Timesheets/Payroll Records • Written Record Retention Policies • Inventory Controls • Conflict of Interest Policy • Organizational chart showing placement of departments/units and individuals responsible for financial and programmatic matters • Meeting minutes and agenda • General ledger listing • Travel policy • Petty Cash or Cash Handling Policy • Budget development and monitoring process • Equipment Disposal records 6.41 CONTINGENCY RELATING TO OTHER AGREEMENTS AND GRANTS: Contractor shall, during the term of this Contract, within 15 business days from acceptance, inform the MCDPH Grant Administrator in writing of the award of any other agreement or grant, including any other agreement or grant awarded by the County, where the award may affect either the direct or indirect costs being paid or reimbursed under this Contract. The Contractor’s failure to notify the County of any such agreement shall be a breach of this Contract and the County may immediately terminate this Contract without liability. The MCDPH Grant Administrator may request, and Contractor shall provide within a reasonable time, which shall not exceed ten (10) business days, a copy of all such other agreements or grants, when, in the opinion of the MCDPH Grant Administrator, the award of the agreement or grant may affect the costs being paid or reimbursed under this Contract. If the MCDPH Grant Administrator determines that the award to the Contractor of such other agreements or grants has affected the costs being paid or reimbursed under this Contract, then the MCDPH Grant Administrator shall prepare an amendment to this Contract effecting a cost adjustment. If the Contractor disputes the proposed cost adjustment, then the dispute shall be resolved pursuant to the "Disputes" paragraph of this Contract. 6.42 DISPUTES: Except as may otherwise be provided for in this Contract, the Parties may attempt to informally resolve any dispute arising out of this Contract for a reasonable period of time which shall not exceed one hundred twenty (120) calendar days. Disputes which are not resolved in that time period shall be submitted in accordance with the following formal dispute resolution process: 6.42.1 If a dispute cannot be resolved informally, then the Contractor shall notify the Department in writing by mailing notice of the dispute to the MCDPH Procurement Page 18 of 37 Officer within ten (10) business days from expiration of the informal dispute resolution process described above. 6.42.2 The MCDPH Procurement Officer shall respond in writing to the Contractor within fourteen (14) business days. The decision of the MCDPH Procurement Officer shall be final and conclusive unless, within seven (7) business days after the date the Contractor is served with the decision, the Contractor files a written notice of appeal with the MCDPH Department Director. 6.42.3 The MCDPH Director shall provide Contractor with a written response within fourteen (14) business days following receipt of the notice of appeal. The decision of the MCDPH Director shall be final and not able to be appealed. 6.42.4 Pending a final decision of the MCDPH Director, Contractor shall diligently proceed with its performance of this Contract in accordance with the MCDPH Procurement Officer’s decision. 6.43 GOVERNING LAW: This Contract shall be governed by the laws of the State of Arizona. Venue for any actions or lawsuits involving this Contract will be in Maricopa County Superior Court, Phoenix, Arizona. 6.44 ORDER OF PRECEDENCE: In the event of a conflict in the provisions of this Contract and Contractor’s proposed initial or best and final response to the solicitation, the terms of this Contract shall prevail. 6.45 INCORPORATION OF DOCUMENTS: The following are to be attached to and made part of this Contract: 6.40.1 Exhibit A, Pricing and Respondent Information 6.40.2 Exhibit B, Scope of Work 6.40.3 Exhibit C, Office of Procurement Services Contractor Travel and Per Diem Policy 6.40.4 Exhibit D, Information Pertaining to Notice of Award for Subrecipients of Grant Funds 6.40.5 Exhibit E, CDC’s General Terms and Conditions for Non-Research Grant and Cooperative Agreements (rev 08/21) 6.46 NOTICES: All notices given pursuant to the terms of this Contract shall be addressed to: For County: For Contractor: Maricopa County Department of Public Health Arizona Pharmacy Association Purchasing & Contracts Unit ATTN: Cheryl Bucalo, Procurement Officer Kelly Fine 4041 N. Central Avenue, #1400 1845 East Southern Avenue Phoenix, AZ 85012 Tempe, AZ 85282 Cheryl.Bucalo@Maricopa.gov kelly@azpharmacy.org (602) 506-6886 Page 19 of 37 Page 20 of 37 EXHIBIT A Page 21 of 37 EXHIBIT B Scope of Work Original Scope of Work from Solicitation 2.0 SCOPE OF WORK: Contractor shall: 2.1 Develop and implement a naloxone distribution program with Maricopa County pharmacies, which includes access to naloxone at low or no cost for those who cannot afford it. Program development should focus on how to increase access to clients wising to obtain naloxone but unable to afford it. Program implementation should be focused on pharmacies in areas of highest need. 2.1.1 In collaboration with MCDPH, identify pharmacies in Maricopa County best positioned to receive reimbursement for offering free naloxone based on fatal/nonfatal overdose data and population level income data. 2.1.2 Negotiate with MCDPH an acceptable rate at which pharmacies will be reimbursed for providing naloxone to those unable to pay. 2.1.3 Develop a process for pharmacies to demonstrate disbursement of and receive reimbursement for naloxone. 2.1.4 Develop and implement an evaluation plan to evaluate program success and opportunities for improvement in collaboration with MCDPH. 2.1.5 Receive written approval from MCDPH prior to implementation of program plan. 2.2 Develop and implement educational campaigns 2.2.1 One initiative should focus on increasing education around the naloxone standing order and reducing stigma among pharmacists and their staff about substance use and naloxone in general. 2.2.2 One initiative should focus on in store community education about how to access naloxone. 2.2.3 In collaboration with MCDPH, develop and implement an evaluation plan to evaluate/document program success and opportunities for improvement. 2.3 Maintain client confidentiality in alignment with applicable state and federal laws that protect client confidentiality of medical, behavioral health and drug treatment information. 2.4 Provide monthly reports to MCDPH to include 2.4.1 Current status of project Page 22 of 37 2.4.2 Quantity of naloxone provided to residents 2.4.3 Accomplishments, challenges, and activities completed during that month 2.5 Understand and comply with all federal requirements related to funding source. Chosen recipients awarded a contract will be considered a subrecipient, which entails a higher level of compliance monitoring. Subrecipients should account for at least one site visit per year, quarterly compliance monitoring, and ongoing engagement with the MCDPH Compliance team when completing budget projections. Any costs incurred for these additional activities must be included in the total proposed budget and all proposed costs are subject to negotiation prior to award as well as to audit reviews upon invoice submission. MCDPH will provide the following: 2.6 Technical assistance for identifying areas of highest need including data demonstrating geographic areas with the highest numbers of fatal and non-fatal opioid overdoses population level income data by geographic area. Technical assistance with developing evaluation plans and ongoing support for implementation of the plan. 2.7 Ongoing review of the establishment and implementation of activities and measures for accomplishing the goals of this agreement. 2.8 Participating, as appropriate, in conference calls and meetings that are conducted during the project period. 2.9 Reviewing and concurring with all information products prior to dissemination. Contractor’s Response 5.1.1 Executive Summary-Revised Background Accessibility The majority of the U.S. population (88.9% and 96.5%) lives within 5 and 10 miles respectively of a community pharmacy.1 As a result, community pharmacists are considered to be the most accessible health care professional and often the only provider in certain underserved areas. Annually, Americans visit their pharmacy 35 times versus 4 visits to their primary care provider 2. Additionally, the number of pharmacies is 15% higher than the number of providers’ offices in communities where more than 30% of households live in poverty.3 This places pharmacies in a unique position to address unmet healthcare needs. Ability to Organize in a Crisis During the COVID-19 pandemic, pharmacy personnel were deemed essential and those in community pharmacy settings were readily available to communicate information, provide services, and protect needed supplies (i.e., distilled water for nebulizers and C-PAP machines and hand sanitizer) from hoarding behavior as the pandemic unfolded. Further, community pharmacies were relied upon to support the emergence and rapidly evolving need for health information and care related to the pandemic.4 As vaccines became available, existing community pharmacy channels and pharmacist knowledge and vaccine administration skills were leveraged to rapidly increase the number of people vaccinated.4 Page 23 of 37 Background of the Problem Maricopa County is the 5th largest metropolitan area in the US and covers a vast area of land, some of which gives rise to communities that are rural or underserved. Even within the metropolitan area, there are communities and populations designated as medically underserved and communities that are negatively impacted by social determinants of health. This fact was amplified during the COVID-19 pandemic as a multitude of strategies were needed to roll out COVID-19 vaccines to reach large populations. Strategies were employed to address those with access to transportation (vaccination Pod’s), underserved populations (mobile clinics), and leveraged those with access to a community pharmacy and pharmacist. A similar multi-pronged approach is needed to address the opioid epidemic. In contrast to vaccination services, community pharmacies have not yet led the Naloxone distribution efforts by maximizing their accessibility. However, the proven utility of community pharmacies in mobilizing and scaling efforts can complement existing community-based outreach efforts that target overdose prevention and reversal for people who take opioids. Utilizing a community pharmacy for Naloxone offers a normalized healthcare source for people who feel a stigma associated with going to a specified clinic location. Approach This proposal describes a strategy to (1) leverage the infrastructure and proven utility of community pharmacies in underserved areas, (2) to equip pharmacy personnel to effectively and confidently facilitate access to Naloxone as a means to mitigate potential harm to patients at high risk for opioid overdose, and (3) to position laypersons to assist those who are at high risk, all while reducing the out-of-pocket cost burden to any individual wanting Naloxone. A recent qualitative study found that community pharmacists see themselves as “the gatekeepers in prevention.” They believe they have a vital role in combating opioid overdose, but are hampered by structural aspects of pharmacy practice and lack of recognition for their role.5 As the organization that represents all pharmacy professionals in Arizona, the Arizona Pharmacy Association (AzPA) is an ideal partner to lead the effort to organize Maricopa County community pharmacy personnel identified in areas where there are populations of underserved people to improve or enhance the availability of Naloxone and to assist community pharmacists across the state to learn more about existing barriers and how to overcome them. Pharmacists and pharmacy technicians will learn best from other pharmacists and pharmacy technicians who understand the operational practice of pharmacy. AzPA will engage pharmacies in Maricopa County to cover areas of the community with the highest need as identified in collaboration with the Maricopa County Department of Public Health (MCDPH). AzPA personnel will invite pharmacies who meet established eligibility criteria to participate as a Naloxone Access and Education Hub (NAEH). Selected pharmacy sites will receive continuing education and training at no-cost, medication remuneration, and a professional fee for Naloxone consultations. Pharmacies will attest to AzPA the level of preparedness of their personnel to work with people for whom Naloxone is needed or wanted. This program consists of utilizing the existing Arizona Department of Health Services’(ADHS) Standing Order for Naloxone when requested by any individual or lay person that wishes to have it on hand for use to reverse the effects of an opioid overdose until emergency personnel arrive. Pharmacy personnel will also identify individuals who may be at risk for opioid overdose (i.e., patients with opioid use disorders, as one example). Naloxone will be processed as a prescription as required by ARS 32-1964, ARS 32-1968, ARS 32-1979, AAC R4-23-407, AAC R4-23-407.1 and recorded in the Controlled Substance Prescription Monitoring Program (CSPMP) as required by ARS 36-2608. Naloxone dispensing will be accompanied by pharmacist point-of-care consultations as required by ARS 32-1979 that will focus on optimal use and the importance of Naloxone in preventing opioid overdose death. For this program, a unique billing code plan will be established, and participating pharmacies will be provided with billing information to process Naloxone prescriptions at no charge for people who do not have insurance or those with commercial insurance plans with copay costs that make it difficult to obtain Naloxone. This unique billing code plan will allow for standardized data capture and reporting for all the participating pharmacies and allow for a simple process for individuals requesting Naloxone. This process is designed to assimilate the program into established pharmacy workflow and provide for potential future program expansion. Evaluation of the program will be conducted monthly in collaboration with MCDPH as required and include elements such as training conducted, pharmacy participation, Naloxone dispensing over baseline, and opportunities for improvement. Beyond the scope of education and training, each participating pharmacy will receive a toolkit with marketing materials to raise awareness amongst pharmacy customers about the availability and importance of Naloxone as well as empower pharmacy professionals to engage in focused and ongoing conversations with patients and laypersons about the importance of Naloxone in preventing opioid overdose deaths. Page 24 of 37 Lastly, AzPA will broaden its education reach to all Maricopa County pharmacies through the design of an education campaign focused on increasing pharmacist awareness and utilization of the Naloxone standing order to make Naloxone available to anyone who requests it. The campaign will be centered around the creation of a microsite (as part of the AzPA website) called Stop Overdose Deaths in AZ (SODA) which will include a pharmacy locator among other resources. While the project is focused upon Maricopa County, SODA and project tools and education housed within it will be available to all pharmacy personnel in Arizona regardless of their participation in this program. References 1. Berenbrok LA, Tang S, Gabriel N, Guo J, Sharareh N, Patel N, Dickson S, Hernandez I. Access to community pharmacies: A nationwide geographic information systems cross-sectional analysis. JAPhA. 2022;62(6): 1816-1822.e2 https://doi.org/10.1016/j.japh.2022.07.003. 2. Fred Gebhart. Pharmacists Want More Time with Patients. Drug Topics Journal. March 2019, Volume163, Issue3. https://www.drugtopics.com/view/pharmacists-want-more-time-patients 3. Popovian R, Winegarden W, Rivera E, Gavigan K. Accessibility of adult immunizations in pharmacies compared to physician offices in low-income communities. Journal of the American Pharmacists Association.2022;62:1644-1647.https://www.japha.org/action/showPdf?pii=S1544-3191%2822%2900094- 2 4. Grabenstein JD. Essential services: quantifying the contributions of America’s pharmacists in COVID-19 clinical interventions. JAPhA. 2022;62(6):1929-1945.e1. https://doi.org/10.1016/j.japh.2022.08.010. 5. Vadiei N, Eldridge LA, Meyerson BE, Agley J. "The gatekeepers in prevention": Community pharmacist perceptions of their role in the opioid epidemic. Subst Abus. 2022;43(1):319-327. doi: 10.1080/08897077.2021.1941516. Epub 2021 Jul 2. PMID: 34214407. Page 25 of 37 5.5.2 Proposal -Revised 5.5.2.1 Methodology/Approach on the Development and Implementation of the Program Phase I: Identify Pharmacy Locations Following the identification of underserved areas of Maricopa County in collaboration with MCDPH, AzPA will utilize its vast network of relationships amongst independently owned pharmacies and larger grocery and chain pharmacy corporations within the underserved area to extend an invitation to participate as a Naloxone Access and Education Hub (NAEH). The goal will be to enroll eligible pharmacies in the Naloxone distribution program focusing first on independent pharmacies, then pharmacies located with grocery locations, followed by chain pharmacy locations due to ease of roll out and less corporate constraints. Pharmacy Participation Criteria ● Located in an identified area of need in Maricopa County. ● Adequately staffed (must be 90% staffed and stable pharmacists’ staff with irregular use of floaters). ● Adequate space for product and Naloxone consultation. ● Ability to obtain Naloxone through existing supply channels. ● Identification of one person in each pharmacy willing to serve as the “Naloxone Champion” to drive the program and serve as a liaison to the AzPA project manager. ● 100% of staff are willing to complete education and training and promote Naloxone distribution. ● Willingness to sign and comply with a written agreement of participation. Pharmacies considered as potential participants in this program will be evaluated using the criteria indicated above and will be finalized in collaboration with MCDPH based upon areas identified with greatest need for underserved populations in Maricopa County as described in the Request for Proposal. The participation criteria will be used to ensure participating pharmacies are well-prepared for successful execution to meet the program goals. It is of the utmost importance for AzPA to be a strong and reliable partner in this program through judicious oversight of resources. <CONFIDENTIAL> Sample of Proposed Pharmacy Locations The representative pharmacy sampling below focuses on the Phoenix metro area; however, other locations within Maricopa County will be considered in consultation with MCDPH to provide a greater reach of services for other communities in need. It is our desire to see this program expanded to additional pharmacy locations not identified in the initial phases of this program. (Note: This list does not represent the final number or exact location of all participating pharmacies. This is meant to demonstrate a sampling of AzPA’s relationship with a variety of local Maricopa County pharmacies as well as recommendations received from our collaboration with a local harms reduction program). Pharmacy Address City State Zip CVS/Pharmacy 711 E. Indian School Road Phoenix AZ 85014-4620 CVS/Pharmacy 3560 W. Peoria Avenue Phoenix AZ 85029-4026 Fry's Pharmacy 4353 W. Bethany Home Road Glendale AZ 85301-5401 Fry's Pharmacy 4329 W. Northern Avenue Glendale AZ 85301-1647 CVS/Pharmacy 3440 W. Glendale Avenue Phoenix AZ 85051-8323 Fairmont Pharmacy 5068 N. Central Avenue Phoenix AZ 85012-1521 CVS/Pharmacy 3502 W. Camelback Road Phoenix AZ 85019-2707 Valley Discount Pharmacy 1245 E Southern Ave #21 Mesa AZ 85204 Rosy’s Pharmacy 1111 E Northern Ave Phoenix AZ 85020 Food City 3442 W Van Buren St Phoenix AZ 85009 Page 26 of 37 Walgreens 710 E. Camelback Road Phoenix AZ 85014-3657 Walgreens 3402 N. Central Avenue Phoenix AZ 85012-2202 Community, A Walgreens Pharmacy 2302 N. Central Avenue, Ste 7 Phoenix AZ 85004-1332 CVS/Pharmacy 1525 N. Central Avenue Phoenix AZ 85004-1646 Phoenix Pharmacy 1701 E. Thomas Road, Ste 105 Phoenix AZ 85016-7672 Walgreens 1616 E. Thomas Road Phoenix AZ 85016-7602 CVS/Target Pharmacy 1625 E. Camelback Road Phoenix AZ 85016-3901 Fry's Pharmacy 100 E. Jefferson Street Phoenix AZ 85004-2752 CVS/Pharmacy 50 W. Jefferson Street, Ste 140 Phoenix AZ 85003-2331 Fry's Pharmacy 4724 North 20th Street Phoenix AZ 85016-4704 On the Go Pharmacy 13660 N 94th Dr, D-1 Phoenix AZ 85053 Fry's Pharmacy 3511 W. Peoria Avenue Phoenix AZ 85029-4037 S & G Drugs 3201 W. Peoria Avenue #B401 Phoenix AZ 85029-4610 Walgreens 4111 North 24th Street Phoenix AZ 85016-6222 Walgreens 3450 W. Dunlap Road Phoenix AZ 85051-5302 Safeway Pharmacy 340 E. McDowell Road Phoenix AZ 85004-1533 Sun Pharmacy 4838 East Baseline Rd #127 Mesa AZ 85206 Walgreens 705 E. McDowell Road Phoenix AZ 85006-2519 Wal-Mart 6145 North 35th Avenue Phoenix AZ 85017-1940 Wal-Mart 9600 N. Metro Parkway W. Phoenix AZ 85051-1402 CVS/Target Pharmacy 10404 North 43rd Avenue Glendale AZ 85302-2019 Bashas Pharmacy 5555 N. Seventh Street, Ste 130 Phoenix AZ 85014-2531 Melrose Pharmacy 706 W Montecito Ave #2814 Phoenix AZ 85013 The suggested list of community pharmacies was identified in a recent qualitative study that examined the experiences of persons who inject drugs (PWID) in Arizona which included the identification of drug copping areas in five Arizona counties, including Maricopa County, through a collaboration between study investigators and a local harm reduction organization.1 <CONFIDENTIAL> Pharmacy Workflow Requests or recommendations for Naloxone will be processed using ADHS Standing Order to generate a prescription that will be entered directly into the existing pharmacy software which mimics regular workflow and complies with Arizona pharmacy law. An additional benefit for utilizing the standing order will be realized should Naloxone undergo a classification change from prescription only to over the counter (OTC) status. It is likely that cost barriers related to OTC status for Naloxone will occur for some individuals where OTC medications are not usually covered by insurance plans unless it is prescribed. A template shelf talker (accompanying signage displayed where the product is located) that can be used in pharmacies to alert the customers of benefit will be provided in the toolkit described below. Participating pharmacies will utilize an assessment form for any patient or layperson requesting Naloxone. The form will be used to collect de-identified, non-patient specific demographic information as well as other information that will be used for reporting, data analysis, and program evaluation. The assessment forms will be faxed to AzPA each month to be reconciled against the billing plan and CSPMP records. Draft Assessment Form (Appendix D) Part 1: The patient or layperson will fill out the top portion of this assessment form. Page 27 of 37 Draft Assessment Form Continued (Appendix D) Part 2: The pharmacist or delegated pharmacy personnel will fill out the bottom portion of the assessment form. Page 28 of 37 Prescription Processing Procedure A unique billing code plan will be created for participating pharmacies to submit payments for the product and professional fee (for the provision of education on the use of Naloxone) when allowed by law and for prescriptions not billed through government plans (i.e., Medicare/Medicaid), but through a commercial plan where the copay creates a barrier to access for an individual. The use of a unique billing code plan will enable reporting and monitoring functions as a proxy for utilization. Additionally, aggregate utilization reports from the Arizona Controlled Substance Prescription Monitoring Program (CSPMP) will be obtained from the Arizona Board of Pharmacy to track overall Naloxone dispensing in participating pharmacy locations compared to baseline. Point of Care for Naloxone Access and Education Illustrated below is a schematic of how Naloxone access and education would be provided to someone who requests it or for a pharmacy personnel who identifies a need for Naloxone at a point of care interaction. <CONFIDENTIAL> Pharmacy Reimbursement Process When pharmacy personnel provide Naloxone assessment and consultations, pharmacists must be reimbursed for the costs associated for procurement, dispensation, and the provision of pharmacist clinical services to optimize the use of Naloxone. This will allow participating pharmacies to sustain their viability, in particular independently owned pharmacies that are facing pressures that threaten their existence in communities including rural areas of Maricopa County. Proposed Pharmacy Reimbursement Structure ● Average nasal Naloxone pharmacy acquisition cost: ($70-$100) ○ The acquisition cost range is based on data from 4 different pharmacy companies. ● Pharmacy Dispensing fee (includes labor, supplies needed to fill prescription): $10. ● Pharmacy Professional fee (includes assessment and counseling): $15. By using a unique billing code plan designed specifically for the NAEH program, Naloxone dispensation reports obtained by the unique billing code will be used to determine what was dispensed by each pharmacy location and the amount that is owed. In addition, the assessment forms will be faxed to AzPA each month to be reconciled against the billing plan and CSPMP records. Invoices will be paid every 30 days according to each pharmacy company's procedures. Phase II: Develop Resources and Education for Participating Pharmacy Personnel (and Others) AzPA is an established and accredited provider of continuing pharmacy education (CPE) for focused education to all pharmacists and other pharmacy professionals on opioid antagonists such as Naloxone. While the initial focus is Page 29 of 37 ensuring that pharmacy personnel working in the participating pharmacies are able fulfill their obligation related to being a AzPA NAEH, these efforts can readily lend themselves to build capacity and grow the number of pharmacies willing to serve as AzPA NAEH in the future. For the purposes of Phase II, efforts are focused on the initial AzPA NAEH cohort. Repurposing and Enhancing Existing Resources AzPA has had a Naloxone Training Program since 2016 which was focused as a knowledge-based training resource for pharmacists to comply with statutory requirements. These training materials can be converted into application- based education materials to address and enhance pharmacist preparedness to provide services to individuals or lay persons who wish to have Naloxone available for others or to patients for whom Naloxone is needed such as patients with opioid use disorder (OUD), patients being treated with opioids at 50 mg of morphine milliequivalents (MME) or higher and/or with concomitant conditions such as sleep apnea. AzPA sees pharmacy technicians and student pharmacists as critical entry points for care at pharmacies and as such, will incorporate training opportunities that target these staff and their roles in the process. Pharmacy technicians and student pharmacists are often the first point of contact for people needing or wanting Naloxone and can assist the pharmacists to help identify and educate them. In addition, the focus on outreach to date has been primarily to patients on high dose opioids with limited focus on laypersons who may be in a position to take action in an overdose. Thus, repurposing materials allows for the scope of the target audience to expand, as well. Education Components AzPA will provide formal CPE with a focus on four key areas throughout the program through virtual platforms, in local programs, and at large in person conferences. The education will focus on 1) promoting the Naloxone standing order, 2) reducing stigmas and barriers to access, 3) engaging with trusted messengers, and 4) health coaching and motivational interviewing. While AzPA would expect the educational needs to vary throughout the course of the project, 4 sessions have been identified for inclusion: Part 1-Naloxone Standing Order: This session will focus on ARS 32-1979 as well as other applicable statutes and regulations governing pharmacy practice to ensure pharmacists are compliant with the law. Learning Objectives: 1. Recognize the symptoms of an opioid overdose. 2. Demonstrate how to respond to a suspected opioid induced overdose. 3. Describe the opioid antagonist dispensing laws that pertain to pharmacists in Arizona. 4. Recognize how to administer various opioid antagonists via all commercially available products. 5. Identify the components of an effective consultation to a patient or caretaker for which an opioid antagonist is dispensed. Part 2-Reducing Stigmas and Barriers to Access: This session will provide a background on OUD and will focus on community pharmacy as the optimal site for intervention and harm reduction. In addition, this session will provide information on stigma and the negative health consequences that can occur by increasing participant awareness of unconscious bias and of other beliefs and attitudes that serve as barriers to effective care. Learning Objectives: 1. Review the literature regarding the pharmacist’s role in the opioid epidemic. 2. Describe the types of innovative practices related to opioid harm reduction that currently exist. 3. Identify Naloxone intervention strategies that can be implemented in community pharmacies to help increase OUD screenings, brief interventions, and referral to community services. 4. Identify unconscious bias and other beliefs and attitudes that serve as barriers to effective care. 5. Apply effective communication strategies when interacting with a patient or caretaker for which an opioid antagonist is dispensed to mitigate stigma associated with OUD and/or medications for use in OUD. Page 30 of 37 Part 3-Engaging with Trusted Messengers: This session will empower pharmacists to identify and partner with local trusted messengers (e.g., community health workers, peer navigators) that represent the population and who can share clear and credible communication. This session will promote Naloxone resources and having bidirectional conversations about the risks of opioid overdose in a safe environment. Learning objectives will be developed by the AzPA Education Committee and AzPA Opioid Overdose Workgroup. Part 4-Health Coaching and Motivational Interviewing: This session would build skills and techniques to help engage patients and empower them to take a more active role in their care and well-being. By providing pharmacists with health coaching training, AzPA can promote confidence, build trust, and help patients develop positive health outcomes for patients with OUD or using medications for OUD. Learning objectives will be developed by the education committee and opioid overdose workgroup. Pharmacy Toolkit AzPA will design a turnkey toolkit which will enable any pharmacy professional affiliated with a participating pharmacy who completes the continuing education training to apply what they learned to their practices and extend education to their patients and store customers and laypeople about the Naloxone access services facilitated by use of the Naloxone standing order. The toolkit will include: ● Customized prescription paper bags to promote Naloxone availability for the first two weeks of the project. ● Bag stuffer (print ready and customizable) ○ Will include a message about free Naloxone and QR code that links to the SODA website. ● Pre-scripted interactive voice response (IVR) messaging ○ Pharmacies can use this script for automated phone systems or for in-store announcements. ● Quick reference guide for pharmacy personnel ○ MME conversion chart ○ Patient conversation starters ○ Billing code plan information ○ Arizona Opioid Assistance and Referral (OAR) line information ● Recommended computer system alerts (i.e., MME >50, Opioid and Benzodiazepine) for programming dispensing systems. “Stop Overdose Deaths AZ” (SODA) Community Awareness Website AzPA will create a website which will include a pharmacy finder of pharmacy locations where free Naloxone can be obtained through this initiative. ● Pharmacy professional resources to be included: tool kit (aforementioned) material downloads for production, referral resources, training program links, copy of standing order, workflow best practices (i.e., schedule appointments for Naloxone consultations), video highlighting Naloxone standing order, OAR line information. ● Community resources to be included: link to website with video regarding Naloxone standing order, how to use Naloxone (lay person perspective), teach someone else how to use Naloxone, pharmacy locator on where to go to get Naloxone, and treatment center referrals. Phase III: Conduct Pharmacy Personnel Training Training Rollout AzPA will design and execute a continuing education program consisting of multiple modalities, including virtual webinars and live, in-person sessions. These sessions as outlined in the ‘Educational Components’ section above will highlight best practices and troubleshoot ongoing challenges seen throughout the Opioid epidemic in getting Naloxone out into local communities. ● Live trainings will be offered for the participating pharmacies Naloxone Champion(s) ● On-demand training will be offered for participating pharmacy staff as well as other non-participating pharmacies through the online education platform Successful completion of the training program will include earning an AzPA certificate as a “Certified Naloxone Educator” (CNE) Page 31 of 37 Phase IV: Naloxone Access and Education Hub Launch The AzPA Project Manager will complete a site visit for each participating pharmacy prior to launch of the program. Any remaining educational or operational gaps will be addressed at that time. Public Service Announcement Campaigns Once a participating pharmacy has completed training and is ready to launch, it will be recognized as an AzPA NAEH and AzPA will issue a press release in the area where the pharmacy is located. Bidirectional Referrals: AzPA will utilize its existing relationships with other community partners and stakeholders involved in opioid overdose education and outreach to bridge gaps seen at the local level to create a bidirectional referral process to and from community pharmacies and AzPA NAEH. Community outreach-Advertising via flyers containing information about the SODA website at various business: ● Caregiver school ● Leverage relationship between other health professional associations to provide education on standing order. ● Outreach to other professional associations to provide education to other healthcare providers about the Naloxone standing order and eligibility of patients and laypeople to obtain the product as an alternative source and how AzPA will help assist with the patient’s copay. Example associations include: ● Arizona Nurse Association ● Arizona Dental Association ● Arizona Medical Association ● Arizona State Association of Physician Assistants ● Arizona Physical Therapist Association ● Arizona Occupational Therapist Association ● Churches and Community-based organizations 5.5.2.2 Evaluation Strategy Phase V and VI Program Evaluation Maricopa County Reporting In collaboration with MCDPH, AzPA will develop and implement an evaluation plan to evaluate/document program success and opportunities for improvement that at minimum will include:. ● Status of project ● Quantity of Naloxone provided to residents. ● Accomplishments, challenges, and activities completed during that month. AzPA Proposed Project Management and Evaluation Plan In addition to standard reporting to MCDPH, it is possible to report on these additional items to understand the impact of program deliverables so that adjustments can be made for quality improvements identified. 1) Continuing Pharmacy Education ● Analysis will be conducted by examining metrics related to pharmacist, student pharmacist, and pharmacy technician engagement with the CPE programming AzPA will create and disseminate. AzPA will identify the number of pharmacists and pharmacy technicians that have attended each webinar or live session. In addition, AzPA will collect results from pre- and post-surveys taken by attendees and collect a detailed evaluation summary from attendees based on CPE analysis. AzPA will also assess perceptions (stigmas) and confidence of pharmacy personnel pre- and post-training. ● AzPA plans to engage 100% of practicing pharmacists and technicians in participating pharmacy locations. ● AzPA will track and disseminate availability of Naloxone CPE and will track the uptake by additional pharmacy professionals not affiliated with the participating locations. 2) Patient Interventions ● AzPA has procedures and safeguards in place that ensure all data collection is handled in a manner that respects patient confidentiality, privacy, and HIPAA regulations. ● AzPA will work with the Arizona CSPMP to run a baseline report of Naloxone dispensations prior to the start of the project and will run a report each quarter of the project to track progress in overall Naloxone dispensing in AZ pharmacies as well as the selected Naloxone Access and Education Hubs. Page 32 of 37 ● Participating pharmacies will utilize an assessment form for any patient or layperson requesting Naloxone. The form will be used to collect de-identified, non-patient specific demographic information as well as other information that will be used for reporting, data analysis, and program evaluation. 3) Descriptive Data ● AzPA will collect and share best practices identified within participating pharmacies. ● AzPA will conduct Naloxone confidence assessments among pharmacy teams to determine any additional education needs. 5.5.2.3 Detailed Timeline for Project Including Specific Deliverables See below and refer to Appendix B DETAILED TIMELINE & DELIVERABLES PROJECT TITLE: NALOXONE PHARMACY DISTRIBUTION PROGRAM PROJECT MANAGER: Kelly Fine COMPANY NAME: Arizona Pharmacy Association DATE: 21-Mar-23 WBS # TASK TITLE TASK OWNER START DATE DUE DATE DURATION % COMPLETE 1 Project Implementation Planning Phase 1.1 Hire Project Manager 5/1/2023 6/1/2023 31 0% 1.2 Sign contract with company to create a “billing code plan” to run uninsured/underinsured claims through for tracking and documentation of free naloxone 5/1/2023 6/1/2023 31 0% 1.3 Identify potential pharmacy locations to contact in collaboration with MCDPH 5/1/2023 6/1/2023 31 0% 1.4 Research cost-effective naloxone purchase options to maximize available doses with provided funding 5/1/2023 6/1/2023 31 0% 2 Phase 1 - Contact and invite pharmacies to participate in the program 2.1 Identify Independent Pharmacies 5/1/2023 11/30/2024 579 0% 2.2 Identify Grocery Chain Pharmacies 5/1/2023 11/30/2024 579 0% 2.3 Identify Retail Chain Pharmacies 5/1/2023 11/30/2024 579 0% 3 Phase 2 - Resource and Education Development 3.1 Education 3.1.2 CE 5/1/2023 8/1/2023 92 0% 3.1.3 Toolkit 5/1/2023 8/1/2023 92 0% 3.1.4 Website 5/1/2023 8/1/2023 92 0% 3.1.5 Marketing Materials 5/1/2023 8/1/2023 92 0% 3.2 Board of Pharmacy CSPMP 3.2.1 Run baseline report of naloxone doses dispensed in participating pharmacies 7/1/2023 7/3/2023 2 0% Page 33 of 37 3.2.2 Invite all pharmacy professionals in AZ as well as guest speakers from MCDPH, and Community partners to discuss opioid epidemic and announce the education and resources developed. 8/1/2023 8/31/2023 30 0% 4 Phase 3- Conduct Pharmacy Training 4.1 Independent Pharmacies 8/1/2023 8/31/2023 30 0% 4.2 Grocery Chain Pharmacies 9/1/2023 9/30/2023 29 0% 4.3 Retail Chain Pharmacies 10/1/202 3 10/31/2023 30 0% 5 Phase 4 - Initiate Naloxone Dispensing 5.1 Independent Pharmacies 9/1/2023 12/31/2024 487 0% 5.2 Grocery Chain Pharmacies 10/1/202 3 12/31/2024 457 0% 5.3 Retail Chain Pharmacies 11/1/202 3 12/31/2024 426 0% 6 Phase 5 - Initiate Program Review 6.1 Quarterly Pharmacy Visits 12/1/202 3 12/31/2024 396 0% 6.2 Monthly conference call with Naloxone champions at each pharmacy 1/1/2024 12/31/2024 365 0% 7 Phase 6 - Monthly MCDPH Reporting 7.1 Project Current Status Report 5/1/2023 12/31/2024 610 0% 7.2 Naloxone Dispense Report 5/1/2023 12/31/2024 610 0% 7.3 Monthly accomplishments, challenges, and activities completed 5/1/2023 12/31/2024 610 0% 8 Phase 7 - Project Closeout Activities 8.1 Communicate to pharmacies, partners, stakeholders on status of project 12/1/202 4 12/31/2024 30 0% 8.2 Prepare final reports for MCDPH 12/1/202 4 12/31/2024 30 0% 8.3 Meet with MCDPH for closeout 12/1/202 4 12/31/2024 30 0% References 1. Meyerson B, et al. Harm Reduct. J. 2019 Sep 18;16(1):57. doi: 10.1186/s12954-019-0327-1. Page 34 of 37 EXHIBIT C OFFICE OF PROCUREMENT SERVICES CONTRACTOR TRAVEL AND PER DIEM POLICY 1.0 All contract-related travel plans and arrangements shall be prior-approved by the County Contract Administrator. 2.0 Lodging, per diem and incidental expenses incurred in performance of Maricopa County/Special District (County) contracts shall be reimbursed based on current U.S. General Services Administration (GSA) domestic per diem rates for Phoenix, Arizona. Contractors must access the following internet site to determine rates (no exceptions): (www.gsa.gov). 2.1 Additional incidental expenses (i.e., telephone, fax, internet and copying charges) shall not be reimbursed. They should be included in the contractor’s hourly rate as an overhead charge. 2.2 The County will not (under no circumstances) reimburse for Contractor guest lodging, per diem or incidentals. 3.0 Commercial air travel shall be reimbursed as follows: 3.1 Coach airfare will be reimbursed by the County. Business class airfare may be allowed only when preapproved in writing by the County Contract Administrator as a result of the business need of the County when there is no lower fare available. 3.2 The lowest direct flight airfare rate from the Contractors assigned duty post (pre-defined at the time of contract signing) will be reimbursed. Under no circumstances will the County reimburse for airfares related to transportation to or from an alternate site. 3.3 The County will not (under no circumstances) reimburse for Contractor guest commercial air travel. 4.0 Rental vehicles may only be used if such use would result in an overall reduction in the total cost of the trip, not for the personal convenience of the traveler. Multiple vehicles for the same set of travelers for the same travel period will not be permitted without prior written approval by the County Contract Administrator. 4.1 Purchase of comprehensive and collision liability insurance shall be at the expense of the contractor. The County will not reimburse contractor if the contractor chooses to purchase this coverage. 4.2 Rental vehicles are restricted to sub-compact, compact or mid-size sedans unless a larger vehicle is necessary for cost efficiency due to the number of travelers. (NOTE: contractors shall obtain pre- approval in writing from the County Contract Administrator prior to rental of a larger vehicle.) 4.3 County will reimburse for parking expenses if free, public parking is not available within a reasonable distance of the place of County business. All opportunities must be exhausted prior to securing parking that incurs costs for the County. Opportunities to be reviewed are the DASH; shuttles, etc. that can transport the contractor to and from County buildings with minimal costs. 4.4 County will reimburse for the lowest rate, long-term uncovered (e.g. covered or enclosed parking will not be reimbursed) airport parking only if it is less expensive than shuttle service to and from the airport. 4.5 The County will not (under no circumstances) reimburse the Contractor for guest vehicle rental(s) or other any transportation costs. 5.0 Contractor is responsible for all costs not directly related to the travel except those that have been pre- approved by the County Contract Administrator. These costs include (but not limited to) the following: in- room movies, valet service, valet parking, laundry service, costs associated with storing luggage at a hotel, fuel costs associated with non-County activities, tips that exceed the per diem allowance, health club fees, and entertainment costs. Claims for unauthorized travel expenses will not be honored and are not reimbursable. Page 35 of 37 6.0 Travel and per diem expenses shall be capped at 15% of project price unless otherwise specified in individual contracts. 7.0 Contractor shall provide, (upon request) with their invoice(s), copies of receipts supporting travel and per diem expenses, and if applicable with a copy of the written consent issued by the Contract Administrator. No travel and per diem expenses shall be paid by County without copies of the written consent as described in this policy and copies of all receipts. Page 36 of 37 EXHIBIT D INFORMATION PERTAINING TO NOTICE OF AWARD FOR SUBRECIPIENTS OF GRANT FUNDS (2 CFR 200.332) § 200.332 Requirements for pass-through entities. All pass-through entities must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and include the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass-through entity must provide the best information available to describe the Federal award and subaward. https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-D/subject-group-ECFR031321e29ac5bbd https://sam.gov/fal/68467c9ed71e498aa904d8ef4970f5ee/view Prime Awardee: Maricopa County Department of Public Health DUNS # and Unique Entity Identifier #: 602062515 LM85MG1513K5 Federal Award Identification Number (FAIN): SLFRP0146 Subrecipient’s Name (which must match the name associated with its unique entity identifier): ARIZONA PHARMACY ASSOCIATION Subrecipient's Unique Entity Identifier (UEI #) (or DUNS # if UEI is not available): Preferably their UEI # rather than their DUN’s # Federal Award Date Date of award to the recipient by the Federal agency: 05/18/2021 Subaward Period of Performance Start and End Date: 1/25/2023 – 12/31/2024 Subaward Budget Period Start and End Date: 1/25/2023 – 12/31/2024 Amount of Federal Funds Obligated by this Action by the pass-through entity to the Subrecipient (this is normally the contract amount): $996,345 Total Amount of Federal Funds Obligated to the Subrecipient by the pass-through entity (including the current financial obligation): $996,345 Total Amount of the Federal Award to Prime Awardee: $871,239,088 Federal Award Project Description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA): Coronavirus State and Local Fiscal Recovery Funds (CSLFRF), SLFRF Name of Federal Awarding Agency: DEPARTMENTAL OFFICES, TREASURY, DEPARTMENT OF THE Pass-through Entity and contact information for awarding official (AO) of the Pass-through Entity: Maricopa County Department of Public Health Mr. Max Porter, Executive Director maxporter@mail.maricopa.gov 602-506-6641 Assistance Listings number and Title - the pass-through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement: 21.027 Identification of whether the award is R&D: No Indirect cost rate for the Federal award (including if the de minimis rate is charged) per § 200.414: 10% Page 37 of 37 EXHIBIT E U.S. Department of the Treasury - Coronavirus State and Local Fiscal Recovery Funds Guidance on Recipient Compliance and Reporting Responsibilities – Final Rule effective April 1, 2022 https://home.treasury.gov/system/files/136/SLFRF-Final-Rule.pdf Compliance and Reporting Guidance: https://home.treasury.gov/system/files/136/SLFRF-Compliance-and-Reporting-Guidance.pdf SLFRF Information listed on Sam.gov: https://sam.gov/fal/68467c9ed71e498aa904d8ef4970f5ee/view PURPOSE: RECIPIENTS OF THE STATE AND LOCAL FISCAL RECOVERY FUNDS (SLFRF) PROGRAM WILL DESIGNATE FINANCIAL ASSISTANCE TO SUPPORT URGENT PUBLIC HEALTH EFFORTS TO DECREASE SPREAD OF THE CORONAVIRUS, REPLACE LOST REVENUE FOR VITAL PUBLIC SERVICES AND HELP RETAIN JOBS, SUPPORT IMMEDIATE ECONOMIC STABILIZATION FOR HOUSEHOLDS AND BUSINESSES, MAKE NECESSARY INVESTMENTS IN WATER, SEWER AND BROADBAND INFRASTRUCTURE, AND COVER THE COST OF OTHER ELIGIBLE ACTIVITIES. ACTIVITIES TO BE PERFORMED: STATES (DEFINED TO INCLUDE THE DISTRICT OF COLUMBIA), U.S. TERRITORIES (DEFINED TO INCLUDE, PUERTO RICO, U.S. VIRGIN ISLANDS, GUAM, NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA), TRIBES, METROPOLITAN CITIES, COUNTIES, CONSOLIDATED GOVERNMENTS, AND NON-ENTITLEMENT UNITS OF LOCAL GOVERNMENT (THROUGH STATES)(COLLECTIVELY "ELIGIBLE ENTITIES") WILL RECEIVE PAYMENTS FROM TREASURY TO USE THE FUNDING FOR THE ELIGIBLE PURPOSES OUTLINED IN THE PROGRAM STATUTE, TREASURY'S IMPLEMENTING REGULATIONS, AND GUIDANCE. END GOAL/EXPECTED OUTCOMES: RECIPIENTS OF THE SLFRF PROGRAM WILL USE FUNDS TO: (1) PROVIDE THE NECESSARY ASSISTANCE FOR HOUSEHOLDS, SMALL BUSINESSES, NONPROFITS, AND IMPACTED INDUSTRIES, SUCH AS TOURISM, TRAVEL, AND HOSPITALITY TO RESPOND TO THE COVID-19 PUBLIC HEALTH EMERGENCY OR ITS NEGATIVE IMPACTS; (2) BE USED TO COVER PREMIUM PAY TO ELIGIBLE WORKERS OF THE GOVERNMENTS PERFORMING ESSENTIAL WORK DURING THE COVID-19 PANDEMIC OR USED TO PROVIDE GRANTS TO ELIGIBLE EMPLOYERS THAT HAVE ELIGIBLE WORKERS WHO PERFORM ESSENTIAL WORK; (3) PROVIDE GOVERNMENT SERVICES, TO THE EXTENT COVID-19 CAUSED A REDUCTION OF REVENUES COLLECTED IN THE MOST RECENT FULL FISCAL YEAR OF THE GOVERNMENT; OR (4) MAKE THE NECESSARY INVESTMENTS IN WATER, SEWER, OR BROADBAND INFRASTRUCTURE. INTENDED BENEFICIARIES: ESSENTIAL WORKERS, HOUSEHOLDS, SMALL BUSINESSES, NONPROFITS, THE GOVERNMENTS OF THE ELIGIBLE ENTITIES, THE GENERAL PUBLIC, ETC. SUBRECIPIENT ACTIVITIES: SUBRECIPIENT ACTIVITIES ARE NOT KNOWN AT THIS TIME. RECIPIENT-SPECIFIC INFORMATION ON USE OF FUNDS WAS NOT AVAILABLE AT THE TIME OF OBLIGATION. PLEASE REFER TO HTTPS://HOME.TREASURY.GOV/POLICY-ISSUES/CORONAVIRUS/ASSISTANCE-FOR-STATE-LOCAL-AND- TRIBAL-GOVERNMENTS/STATE-AND-LOCAL-FISCAL-RECOVERY-FUNDS FOR UPDATES ON RECIPIENTS' USE OF FUNDS IN THE PROGRAM.