AGREEMENT RE PRODUCT REPLENISHMENT PROGRAM WITH PFIZER.PDF

C 3- 00
Sharing the Care Product Replenishment Master Agreement
This Agreement is entered into as of the 29 th of April, 2013 by and between Pfizer Patient
Assistance Foundation, Inc. having its principal place of business at 135 East 42 nd Street, New York, New
York, 10017 ("PPAF") and Maricopa County Department of Public Health, Healthcare for the Homeless,
220 South 12 th Avenue, Phoenix, AZ 85007.
WHEREAS, PPAF, through its Sharing the Care ("STC") Product Replenishment Program (the "Program"),
provides certain outpatient prescription products, at no cost, through a product replenishment program
to eligible entities for eligible patients; and
• WHEREAS, the Institution is an eligible entity, as defined in Section 2 of this Agreement, each party
agrees as follows:
1. The Program
1.1 In accordance with the terms set forth below, and so long as Institution abides by the
terms of this Agreement and its Addendum and the STC Program Operations Guide
issued by PPAF, attached herein and made a part of this Agreement, PPAF shall provide
certain outpatient prescription products to institution for Eligible Patients (as defined
below). PPAF shall determine which products shall be included in the Program
("Program Product").
2. Eligibility to Participate in the Program
2.1 Institution Eligibility. In order to participate in the Program, the Institution must be
eligible as defined in the Addendum attached hereto and made a part of this
Agreement.
2.2 Patient Eligibility. In order to participate in the Program, the patient must be eligible as
defined below ("Eligible Patient").
(a) Patient has a household income that is equal to or below 200% of the federal
poverty level.
(b) Patient is not covered by any public assistance or private insurance covering
pharmaceuticals, including but not limited to enrollment in Medicaid, Medicare, and
Veteran's health benefits. For the purposes of this Program, "Public Assistance"
includes eligibility for medical assistance under a "spend-down" provision; and
(c) Patient is registered at the Institution.
(d) Homeless and migrant workers may be presumed to be Eligible Patients.
3. Principal Obligations of Institution
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Sharing. the Care Master Product Replenishment Agreement
3.1 Institution shall be responsible for the dispensing and use of Program Product under the
Program in accordance with this Agreement and with the STC Program Operations Guide issued by
PPAF and attached to this Agreement.
3.2 Institution shall maintain its eligibility status throughout the term of this Agreement and
shall advise PPAF immediately should Institution no longer be eligible in accordance with Section 2.1.
The Institution represents that it shall obtain and maintain in good standing all required federal, state and
local licenses, certificates and permits that are necessary to allow the Institution, the Institution's
pharmacy and the Institution's pharmacist (as applicable) to dispense Program Product to Eligible
Patients.
3.3 Institution shall determine patient eligibility in accordance with Section 2.2.
3.4 Institution shall have in place adequate procedures to ensure accurate identification of
Eligible Patients. Institution shall reconfirm patient eligibility at least annually. Institution shall verify
that Medicare patients do not have prescription drug coverage through Medicare. During the interim
period, if Institution learns that patient is no longer eligible in accordance with Section 2.2, Institution
shall no longer dispense Program Product to such patient.
3.5 Institution shall verify income eligibility based on one or more of the following types of
documentation and upon request must be able to provide to PPAF proof that eligibility was verified:
(a) Institution agrees that the primary documentation it will collect for determining
household income is the patient's Federal Tax Return (1040, 1040EX, etc.), If
the patient does not file a Federal Tax Return, Institution must obtain alternative
documentation of household income. Acceptable alternative documentation
include (i) W-2 form, (ii) a Social Security Statement or 1099 form (SSA 1099,
1099-DIV. 1099-1NT), or (iii) a physician's or recognized advocate's letter
attesting that the patient does not have a social security number, has no
pharmaceutical coverage, and the patient's household produces zero income. For
each patient, the sum of all proofs of income will be the total household income
for determining eligibility.
3.6 The Institution agrees that it shall not dispense any Program Product except as provided
hereunder, including, without limitation, that it shall not sell or transfer any Program Product to any third
party other than an Eligible Patient as provided herein or seek payment or reimbursement from any third
party, including Eligible Patients, for any Program Product. Institution shall credit the Program for any
Program Product for which Institution ultimately receives payment or reimbursement from a third party
and shall have in place adequate procedures to identify such instances on a timely basis.
3.7 Institution and its prescribers shall have the autonomy to follow their routine prescribing
practices and shall take reasonable steps to ensure that their pharmacists prevent, consistent with state
law, substitution of any Program Product prescribed. PPAF shall provide replenishment product only for
Program Product dispensed as prescribed and as specified in the STC Program Operations Guide.
3.8 Institution shall be responsible for (a) instructing all staff regarding program
requirements and procedures, (b) ensuring that adequate procedures are implemented to confirm accurate
identification of Eligible Patients, (c) designating a lead submitter and alternate submitters (the
"Submitters"), a lead approver and alternate approvers (the "Approvers"). Submitters must be members
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Sharing the Care Master Product Replenishment Agreement
of Institution's Pharmacy staff. Approvers must be members of Institution's Executive Management
team. Only Submitters and Approvers shall have the authority, respectively, to submit and approve
Utilization Summary Tables ("USTs") within the STC secure website, internet voucher processing
("iVP"). Institution shall be responsible for informing PPAF ten (10) days in advance in writing of any
changes in Approvers and Submitters, and (d) submitting, revising and approving USTs on a scheduled
basis as determined by mutual agreement, but not less than at least once monthly.
3.9 The Institution shall notify PPAF within thirty (30) calendar days of the date of this
Agreement if Institution should add, remove, or modify any kind of dispensing fees to patients. Both
parties agree that in no event shall the Institution apply a dispensing fee that exceeds ten dollars ($10) per
prescription (or per 30-day supply, if more than a month supply is dispensed at one time) for patients.
3.10 The Institution shall notify PPAF within thirty (30) calendar days if it receives any
Program Product that appears to have been shipped in error or that has been damaged or is otherwise
received in an adulterated or unusable condition.
3.11 The Institution shall notify the PPAF within thirty (30) calendar days of the date of this
Agreement if there is a change to the Institution's Executive Director or Pharmacy Director.
3.12 Institution's execution and performance of this Agreement (a) will comply with all
applicable laws and regulations, including all Regulatoty Requirements, as defined in Exhibit A, (h) will
not violate or infringe upon the rights of any third party, including any Eligible Patient, and (c) will not
conflict with or violate any agreement Institution has or will have with any other person or entity.
3.13 The Institution shall deliver to PPAF a written statement on no less frequent than an
annual basis and more frequently on the request of PPAF which (a) describes the contributed Program
Product, stating the date of receipt and the amount received on that date; and (b) represents that (i) the
Institution is an organization described in section 501(c)(3) of the Internal Revenue Code of 1986, as
amended (the "Code"), (ii) the Institution's use and disposition of the Program Product shall be related to
the purpose constituting the Institution's basis for exemption pursuant to Code Section 501, (iii) the
contributed Program Product is to be used solely for the care of the ill, the needy or infants, and (iv) the
Institution will maintain adequate books and records that will be made available to the Internal Revenue
Service upon request, as set forth in U.S. Treas. Reg. I.170A-4A(b)(4). PPAF will provide Institution
with the form of the written statement. To the extent the written statement is to be delivered to PPAF
annually, the statement shall be delivered to PPAF within thirty (30) days after the form of the written
statement is given to the Institution by PPAF, or by such other date as required by PPAF. If PPAF asks
that the written statement be provided more frequently, it will be delivered to PPAF by a date determined
by PPAF.
3.14 In the event Institution becomes aware of adverse reactions or events ("Adverse Events")
and product quality complaints ("Drug Product Quality Complaints") that may be associated with
Program Product, Institution shall inform PPAF within twenty four (24) hours in accordance with the
STC Program Operations Guide. Institution shall use commercially reasonable efforts to ensure that all
employees and contractors shall comply with these requirements.
3.15 Institution represents and warrants that it is compliant with the Health Insurance
Portability and Accountability Act ("HIPAA") and the HIPAA Regulations and has safeguards to protect
the confidentiality of Patient Health Information ("PHI"), including Electronic Protected Health
Information, as those terms are defined under HIPAA, and to detect, remedy, mitigate and report any
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breaches of that confidentiality to PPAF.
3.16 Institution has, in accordance with HIPAA and the HIPAA Regulations, entered into a
Business Associates Agreement, as defined in the HIPAA Regulations, with any person who will perform
or assist in the perfounance of Institution's responsibilities or obligations under this Agreement which
involve the use or disclosure of PHI, providing, inter alia, safeguards to protect confidentiality of the PHI
and to remedy, mitigate and report any breaches of that confidentiality to PPM.
4. Principal Obligations of PPAF
4.1 In accordance with the procedures set forth in Section 5 below, PPAF shall provide
Program Product at no charge to Institution for Eligible Patients.
4.2 PPAF shall provide Institution with a list of all products provided through the Program.
Only products included on this list will be provided by PPAF through the Program. PPAF will send
product announcements to Institutions when products are added and deleted from the Program.
4.3 PPAF shall assign a direct account number to Institution which shall be restricted to use
with Program Product.
4.4 PPAF shall provide instructional materials consistent with the terms of this Agreement
and maintain a toll-free customer service number.
5. Replenishment Procedures
5.1 In order to be replenished on an ongoing and consistent manner, Institution shall submit
USTs at least monthly to PPAF's secure website, iVP. USTs will be collected in iVP and at least once
per month approved line items will be processed as Purchase Orders (POs) and submitted for
replenishment.
5.2 Thereafter, as needed, PPAF shall ship Program Product at least monthly such that
Institution's Program Product inventory is replenished according to PPAF's records of USTs submitted.
5.3 Each UST shall be accompanied by electronic approval from Submitter and Approver
stating that the information on such UST is true and correct and that each patient to whom Program
Product was provided is an Eligible Patient.
5.4 USTs submitted to iVP after six (6) months of the dispense date will not be valid.
5.5 PPAF shall ship Program Product in response to National Drug Codes (NDCs) submitted
in the USTs.
6. Confidentiality and Privacy
6.1 The identity of patients shall be protected at all times by the parties. The parties shall
limit the disclosure of patient information pursuant to this Agreement to the minimum amount necessary
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for the administration and validation of the Program. In the event of an audit by PPAF pursuant to
Section 7 of this Agreement, the Institution shall not be required to disclose any information as to patient
identity except as necessary for verification of patient eligibility for the Program. PPAF shall not use
patient information disclosed to PPAF by Institution pursuant to this Agreement for any purpose other
than the administration and validation of the Program and shall require its agents, including vendors and
contractors, to agree in writing to the same restrictions and conditions regarding patient information as are
applicable to PPAF under this Agreement.
6.2 Institution shall ensure that neither it nor its Business Associates, as defined under
HIPAA and the HIPAA Regulations, discloses to any third parties, other than Eligible Patients and other
third parties permitted under HIPAA and the HIPAA Regulations and any applicable state law, the fact
that an Eligible Patient has received a prescription for a Program Product. Institution shall take all
reasonable steps to protect the confidentiality, privacy and security of Eligible Patients' PHI.
6.3 Institution agrees that PPAF may release general information about Institution's
participation in the Program. The information may include but is not limited to the name, address and
phone number of the Institution (the "Information"). Both parties agree that PPAF shall have the right to
use Information in a "clinic finder" tool on the Pfizer Helpful Answers website. The clinic finder will
provide a list of institutions that participate in the Program within a twenty five (25) mile radius of a zip
code provided by website user. Institution further agrees to allow the Pfizer. Helpful Answers call center
to provide, when asked, a list of institutions participating in the Program within a 25 mile radius of the zip
code provided by the caller. PPAF agrees not to use the Institution's name in any further publicity
without the prior authorization of the Institution.
6.4 PPAF agrees that Institution may release general information about its participation in the
Program. Institution agrees not to use the STC, Pfizer Inc. or PPAF name in any further publicity without
the prior authorization of PPAF.
6.5 Each party shall, at all times during the term of this Agreement and thereafter, maintain
(and cause its directors, officers and employees to maintain) the confidentiality of any proprietary
information, documents and data relating to the other party.
6.6 For the sake of clarity, the disclosure of Institution proprietary information or patient
information by PPAF to Pfizer Inc. shall not be construed as a violation of this Section 6.
7. Records and Audit
7.1 Institution shall maintain books and records relating to its performance of this
Agreement, including but not limited to patient eligibility records, prescriptions, medical records,
dispensing records, inventory records of product on hand, vouchers, and submitted and approved USTs in
iVP ("Records") in accordance with sound business practice and as may otherwise be required by
applicable law, during the term of this Agreement and for a period of not less than three (3) years after
expiration or termination of this Agreement.
7.2 PPAF shall have the right, at any time, to conduct an onsite audit of Records related to
the Program and the usage of Program Product upon seven (7) business days notice during Institution's
usual business hours in order to ensure accuracy and completeness of the Records and compliance by
Institution with this Agreement and with the STC Program Operations Guide. The identity of patients
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Sharing the Care Master Product Replenishment Agreement
need not be disclosed except as necessary for verification of patient eligibility for the Program.
Institution agrees to cooperate with such audits. Audit rights shall survive the termination or expiration of
the Agreement for a period of twelve (12) months. PPAF may provide a copy of the audit findings to
Institution; at its sole discretion.
7.3 Institution shall cooperate with PPAF to confirm that it continues to meet the criteria for
participation in the Program. PPAF shall have the right to conduct an online survey to re-certify the
Institution's compliance with this Agreement and with the STC Program Operations Guide. Re-
certification shall not be required more frequently than once every two (2) years.
7.4 PPAF shall have the right to suspend or terminate the participation of the Institution in
the Program, in accordance with Section 9, at the sole discretion of PPAF, if the Institution does not
respond to the online survey within required timeframe, to be not less than fifteen (15) business days after
the survey distribution date.
8. Program Discrepancies
8.1 Upon request by PPAF, Institution will provide PPAF with information relating to
Program prescriptions, USTs and dispensing sufficient to ensure PPAF's satisfaction that Program
Products have been prescribed and dispensed to Eligible Patients in accordance with this Agreement and
with the STC Program Operations Guide. PPAF shall make reasonable attempts to use available
information rather than requiring Institution to generate new information solely for this purpose,
8,2 In the event of a discrepancy in information provided by Institution concerning its
participation in the Program, PPAF will send a written notice to Institution detailing the discrepancies and
(a) requesting clarification or evidence of corrective action within thirty (30) days and/or (b) informing
Institution that PPAF will conduct an audit of pertinent records of Institution, at PPAF's expense, to be
conducted upon reasonable notice and during normal business hours. The identity of patients shall not be
disclosed. Institution agrees to cooperate with such audits. At PPAF's sole discretion, it may provide a
copy of the audit findings to Institution.
8.3 While both parties to this Agreement are entering it in order to serve the ill, needy or
infant indigent patients, and while both parties will strive to resolve misunderstandings with a minimum
of inconvenience to all concerned, in the event that discrepancies cannot be resolved to PPAF's
satisfaction, PPAF reserves the right to terminate this Agreement immediately and without adversely
affecting the continuation of Program with other institutions.
9. Term and Termination
9.1 This Agreement shall be effective as of the date first written above and shall continue for
one (1) year, automatically renewable for one (1) year terms thereafter unless earlier terminated in
accordance with Section 7.4, Section 8.3, or Section 9,
9.2 This Agreement may be terminated upon the occurrence of any of the following events:
(a) Either party shall have the right to terminate this Agreement without cause upon
forty-five (45) days' notice to the other party. PPAF shall have the right to
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Sharing the Care Product Replenishment Master Agreement
11.4 Successors and Assigns; Assignment. This Agreement is solely for the benefit of the
parties hereto and their respective successors and permitted assigns. This Agreement may not
be assigned by either party hereto without the prior written consent of the other party hereto.
11.5 Governing Law. This Agreement shall be governed by the laws of the State of New York,
without regard to principles of conflicts of law. All actions and proceedings arising out of or
relating to this Agreement will be heard and determined in any Maricopa County State or
Federal court sitting in the City of Phoenix, Arizona and each of the parties hereto irrevocably
submits to the exclusive jurisdiction of such courts.
11.6 Entire Agreement; Amendment: Effect of Other Agreements. This Agreement, the SIC
Program Operations Guide, and the Exhibits and Addendums hereto represent the entire
understanding and agreement between the parties hereto with respect to the subject matter
hereof. This Agreement can be amended, modified, supplemented, extended, terminated,
discharged or changed only by an agreement in writing which makes specific reference to this
Agreement which is signed by the parties hereto. The parties agree that the terms of this
Agreement supersede any other agreements or understandings, whether written or verbal,
related to the subject matter hereof.
11.7 Severability. Should any part, term or condition hereof be declared illegal or
unenforceable, the validity of the remaining portions or provisions of this Agreement shall not
be affected thereby and the illegal or unenforceable portions of the Agreement shall be
enforceable to the fullest extent allowed by law, while leaving the remaining portions of this
Agreement intact.
11.8 Ownership. All rights (including, but not limited to, copyrights), title and interests in
and to the Program and any written materials developed for or used in the Program shall be the
sole and exclusive property of PPAF. PPAF acknowledges and agrees that Institution may use
such materials for the performance of its services under the Program in accordance with this
Agreement.
11.9 Trademarks. Neither party may use a trademark or trade name owned by the other
party without such other party's prior written authorization. Nothing in this Agreement shall be
interpreted to grant either party any license or other rights with respect to trademarks or trade
names owned by the other party.
11.10 Non-Waiver. The failure of either party to insist upon the strict observation or
performance of any provision of this Agreement, or to exercise any right or remedy shall not
impair or waive any such right or remedy in the future. Every right and remedy given by this
Agreement to the parties may be exercised from time to time as often as possible.
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Sharing the Care Master Product Replenishment Agreement
IN WITNESS THEREOF, the parties hereto have each caused this Agreement to be executed as of the
date first written above by their duly authorized representatives.
Please note that this agreement must be signed by the Executive Director, Pharmacy Director, CEO, CFO
or Medical- Director of the Institution,
Healthcare Institution fizer Pafient Assistance Foundation, inc.
By: By:
(Signature)
Name Tashea Holdip
(Print or Type) (Print or Type)
Title: Patient Assistance Specialist
Title: 1-10 7/2a7, ,, raii,i
(Print or Type) / (Print or Type)
Date: , 24)/ '3 Date:
(Print oit‘ Tyi4e) (Print or Type)
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Sharing the Care Master Product Replenishment Agreement
Exhibit A
Definitions
I. Regulatory Requirements: The requirements of all applicable federal, state and local laws and
regulations and court rulings and consent decrees and all requirements, guidelines, policies and orders
of all governmental bodies or agencies having jurisdiction over each of Institution and PPAF and their
respective employees and agents with respect to activities undertaken pursuant to this Agreement.
Regulatory Requirements include, but are not limited to, the following:
a) the Medicare anti-kickback statute, 42 U.S.C. § 1320a-7h, and all regulations, guidelines and
policies related thereto, including, but not limited to, 42 C.FR. Parts 1000-1008 and the
Department of Health and Human Services' "Special Fraud Alert, Prescription Drug
Marketing," 59 Fed, Reg. 65372 (Dec. 19, 1994));
b) laws concerning fraud, unfair and deceptive trade practices, false claims and privacy
including, but not limited to, the Federal Trade Commission Act, 15 U.S.C. § 41 et seq.; 18
U.S.C. §§ 287, 1001; the False Claims Act, 31 U.S.C. § 3729 et seq.; and the Fraud Civil
Remedies Act, 31 U.S.C. § 3801 et seq.;
c) the federal Food, Drug, and Cosmetic Act, 21 U.S.C. § 301 et seq. and related regulations,
including but not limited to adverse event reporting;
d) laws concerning telemarketing, including the Telephone Consumer Protection Act, 47 U.S.C.
§ 227, and the Telemarketing Consumer Abuse Prevention Act, 15 U.S.C. § 6101, et seq., and
related rules and regulations;
e) laws concerning antitrust including, but not limited to, the Clayton Act, 15 U.S.C. § 12 et seq.
, and the Sherman Act, 15 U.S.C. § I et seq.; and laws concerning patient privacy, including,
but not limited to, HIPAA and the HIPAA Regulations, and state statutes and regulations
concerning patient.
2. Adverse Event: An Adverse Event is any untoward medical occurrence in a patient, clinical
investigation subject, or consumer administered a Pfizer product which could be drug, biologic,
medical device, vaccine, nutritional product or dietary supplement. The event need not necessarily
have a causal relationship with the treatment or usage.
3, Drug Product Quality Complaint: A complaint related to physical properties, labeling, potency or
the packaging of a product.
4. Pfizer Helpful Answers: STC is part of Pfizer Helpful Answers, a family of patient assistance
programs providing medicines free of charge or at a savings to uninsured and underinsured patients
who qualify.
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Sharing the Care Community Health Center with
In-House Pharmacy Addendum
This Agreement is entered into as of the 2nd day of October, 2013 by and between Pfizer Patient
Assistance Foundation, Inc. having its principal place of business at 235 East 42nd Street, New York,
New York 10017 ("PPAF") and HOMELESS HEALTH SYSTEMS INC., 220 SOUTH 12 TH AVENUE,
PHOENIX, AZ 85007.
This Agreement serves as an addendum to the Sharing the Care Product Replenishment Master
Agreement executed by the parties and dated April 29, 2013 (the "Master Agreement"). Capitalized
terms not defined herein are as defined in the Master Agreement. In case of any inconsistency between
this Agreement and the Master Agreement, the Master Agreement controls.
WHEREAS, PPAF, through its Sharing the Care ("STC") Product Replenishment Program (the
"Program"), provides certain outpatient prescription products, at no cost, through a product replenishment
program to eligible entities for eligible patients; and
WHEREAS, the Center is an eligible entity (as defined below), and desires to participate in the Program.
WHEREAS, in furtherance of its exempt purposes, PPAF desires to assist the Center in meeting the
prescription drug needs of the Center's low-income uninsured patient population;
NOW THEREFORE, in consideration of the mutual covenants contained in this Agreement, each party
agrees as follows:
1. Center Eligibility
1.1 In order to participate in the Program, the Center must be eligible as defined below.
(a) Center is an organization described in section 501(c)(3) of the Internal Revenue
Code of 1986, as amended;
(b) Center must be funded under Sections 330(e), 330(g) or 330(h) of the Public
Health Service Act or be a Certified Federally Qualified Health Center Look-
Alike;
(0) Except upon prior written exception by PPAF, only those programs included in
the Scope of Project of the Center's 330(e), 330(g), 330(h) grant(s) or the
Center's Federally Qualified Health Center Look-alike Certification will be
eligible for Program participation. Only those patients covered by one or more of
these grant(s) may be considered for Program eligibility;
(d) The Center must have an in-house pharmacy. An in-house pharmacy is defined
as a pharmacy owned and operated by Center where the Center purchases
pharmaceuticals from a manufacturer or wholesaler directly or through a buying
group and whose pharmacy license requires that pharmaceuticals be dispensed by
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Sharing the Care Community Health Center with In-House Pharmacy Addendum
a pharmacist. This condition cannot be met by contract arrangements with retail
pharmacies. The pharmacy is expected to be open during normal business hours
of Center operation.
2. Inventory Management
2.1 PPAF determines the Center's initial Program Product inventory. Initial Program Product
inventory levels are based on PPAF's analysis of various sources of available Program information and
experience/estimates from Center of utilization of Program Product. Subsequently, Program Product
inventory shall be replenished on a pill for pill basis through the Center's submission of USTs.
2.2 PPAF shall ship the initial inventory of Program Product to the Center for Eligible
Patients.
2.3 In order to avoid commingling PPAF Program Product with Pfizer products for patients
not enrolled in the Program, Institution shall obtain, for non-Program patients, Pfizer products through its
regular Pfizer direct account or through a wholesaler. The Institution shall provide effective physical and
security controls and operating procedures to guard against theft and diversion of Program Product. In
addition, the Institution represents and warrants that any Program Product that falls under the category of
Controlled Substance as defined by 21 USC, Section 802 shall be kept in accordance with state laws.
2.4 Center shall manage Program Product inventory in accordance with applicable federal
and state laws. This includes properly discarding expired Program Product in accordance with procedural
requirements. Moreover, when Program Product is discarded, Center shall document this and request
required replacement Program Product from PPAF.
1N WITNESS THEREOF, the parties hereto have each caused this Agreement to be executed as of the
date first written above by their duly authorized representatives.
Please note that this agreement must be signed by the Executive Director, Pharmacy Director, CEO, CFO
or Medical Director of the Institution.
Comm dint ''Healtit ..Ce.ii -el. Eifiz,er Patient Assistance Foundation, Inc.
B • By:
(Signature) (Signature)
Name: Name: Tashea Holdip
(Print or Type) (Print or Type)
Title: Patient Assistance Specialist,
Title: Pfizer Helpful Answers
(Print or Type) (Print or Type)
Date: Date:
(Print or Type) (Print or Type)
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Pfizer Patient Assistance Program C-8644444-3-00
IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Deputy Attorney for Maricopa County
Air
Date