BUSINESS INTEGRITY. Administrator agrees to be bound by the provisions set forth at 45 CFR Part 76, or any successor provisions. In addition to the foregoing, Administrator represents, warrants and covenants that neither Administrator nor, to Administrator’s knowledge, any pharmacists, prescribers, or other personnel furnishing Covered Prescription Services to Members at Administrator’s Mail Order Pharmacy or any Network Pharmacy, or other agent, employee or subcontractor (including any key management, executive staff or five percent (5%) or greater owner) engaged by Administrator to perform any of the Services have been or is currently (i) sanctioned under, listed as debarred, excluded, suspended, proposed for debarment, or otherwise ineligible for participation in federal or state health care programs (including but not limited to Medicare, Medicaid or CHIP), or (ii) convicted of a criminal felony or has a civil judgment entered against it for fraudulent activities. In addition, Administrator shall review, and shall require its subcontractors and Network Pharmacies to review, the federal government lists of debarred entities and individuals, including but not limited to the DHHS OIG and General Services Administration exclusion lists for any employee, board member, officer, or subcontractor to determine if any such individual or entity is included on such lists upon hire and on at least an monthly basis thereafter. If at any time Administrator becomes aware of any violation of this representation and warranty, Administrator agrees to notify United in writing immediately. In the event that any Network Pharmacy or other agent, employee or subcontractor performing any portion of the Services or its personnel becomes debarred or ineligible for participation in a federal or state health care program or convicted of a criminal felony or otherwise fails to satisfy the business integrity standards of this Section 4.2, then Administrator, upon becoming aware of the situation, shall immediately discontinue its, his or her participation in the Pharmacy Network (as defined in Section 3.1 of Exhibit C) and prohibit it, him or her from furnishing any Covered Prescription Services to Members or discontinue using it, him or her in the performance of any Services if such is not remedied to Administrator’s and United’ satisfaction.
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Sources: Prescription Drug Benefit Administration Agreement, Prescription Drug Benefit Administration Agreement, Prescription Drug Benefit Administration Agreement