Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateXxxxx Xxxxxx Signature: Signature: _ Print Name: Xxxxxxx Xxxxx_Peter Shalit Print Name: Amr Elebiary, RPhPharm.D., MS MBA Address: _000 Xxxxx Xxxxxx, Suite 850 Title: Regional VP of Operations – East West Division City/State/Zip: _Xxxxxxx XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _WAMD00023946 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 319, 2022 Date: 1/19/2022 | 9:03 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Drug Therapy Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Physician Signature: Signature: Print Name: _Mark Xxxxxxx Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _000 Xxxxxxx Xxxxxx, xxxxx 000 Title: Regional VP of Operations – East Division City/State/Zip: _Xxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _NY 201382 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 Date: 1/4/2022 | 7:53 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateXxxxxx Xxxxxxxx Signature: Signature: Print Name: Xxxxxxx Xxxxx_Daniel Xxxxxxxx Print Name: Amr Elebiary, RPhPharm.D., MS MBA Address: _S7563 Xxxxx Xx Title: Regional VP of Operations – East West Division City/State/Zip: _Xxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _29039 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 12/14/2021 | 7:53 AM 1:55 PM PST Date: Signature: Print Name: Xxxxxxx XxxxxXxxxxxx, RPh, MS RPh Title: Regional VP of Operations – East South Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Andrew Magnet, MD, PhD Address: _000 Xxxxx Xxxxxx, 2000 Xxx 000 Xxxxxxx City/State/Zip: _Xxx XxxxXx. Xxxxx, XX 00000 Medical License#: _NY 224860 60215 Phone#: _000-000-0000 Date: _Jan 3Dec 14, 2022 2021 Authorizing Physician Signature: Genoa Healthcare, LLC: Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Georgia Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Georgia Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Georgia Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Georgia Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Georgia Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Georgia Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Georgia Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Georgia Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Georgia Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Georgia Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Georgia Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Georgia Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Georgia Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-32 A-27 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-28 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit X-00 XXXXX-00 Vaccines Moderna: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/moderna/downloads/standing-orders.pdf Pfizer-BioNTech: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/pfizer/downloads/standing-orders.pdf Xxxxxxx, Inc (Xxxxxxx & Xxxxxxx): xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/xxxxxxx/downloads/Xxxxxxx-Standing-Orders.pdf Attachment 1: Pharmacist Affidavit to Qualifications AFFIDAVIT OF STATE OF GEORGIA COUNTY OF Personally appeared before me, the undersigned officer who is duly authorized by law to administer oaths, , who, after first being sworn, states the following of (his/her) own personal knowledge:
Appears in 1 contract
Samples: Vaccine Protocol Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Print Name: Xxxxxxx XxxxxAmr Elebiary, RPhPharm.D., MS MBA Title: Regional VP of Operations – East West Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Date: 11/22/2021 | 11:43 AM PST Signature: Print Name: _Xxx Xx Rushdi Alul Address: _000 Xxxxx Xxxxxx, Xxx 000 City2233 Xxxx Xxxxxxxx Xxxxxx Xxxx/StateXxxxx/ZipXxx: _Xxx XxxxXxxxxxx, XX 00000 Medical License#: _NY 224860 000.000000 Phone#: _000-000-0000 x0000 Date: _Jan 3, 2022 1/10/22 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Only physicians may administer yellow fever vaccine.14 Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx STEVEN XXXXXXXXXX Address: _000 Xxxxx Xxxxxx, Xxx 000 98 Woodchuck Hollow Road City/State/Zip: _Xxx XxxxXxxx Xxxxxx Xxxxx, XX 00000 Medical License#: _NY 224860 181989 Phone#: _000-000-0000 Date: _Jan 3, 2022 Authorizing Physician Signature: Genoa Healthcare, LLC: Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Print Name: _STEVEN XXXXXXXXXX Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _00 Xxxxxxxxx Xxxxxx Xxxx Title: Regional VP of Operations – East Division City/State/Zip: _Cold Xxxxxx Xxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _NY 181989 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 Date:1/4/2022 | 7:53 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Xxxx Xxxxxx, MD Signature: Print Name: _Lane Beatty, MD Print Name: Xxxxxxx Xxxxx, RPh, MS 000 Xxxxxxx Xxxxx Xx. Xxxxx 0 Address: Xxxxxxxx, XX 00000 City/State/Zip: Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _NH 11344 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 11:37 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 RPh may not administer in New Hampshire Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: [Signature Page Follows] Signature: Print Name: Xxxxxxx _Xxxxx X Xxxxxxxx Address: _1181 Xxxx 000xx Xxx Xxxx/Xxxxx/Xxx: _Xxxxxxxx, RPhXX 00000 Signature: Print Name: Amr Elebiary, MS Pharm.D., MBA Title: Regional VP of Operations – East West Division Address: 000 X. Xxxxx Way, Suite 700 Authorizing Practitioner Signature: Genoa Healthcare, LLC: City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 SignatureDate: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 11/19/2021 | 9:37 AM PST Medical License#: _NY 224860 46156 Phone#: _000-000-0000 Date: _Jan 3, 2022 1/5/22 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Pharmacist Administered Vaccines
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Print Name: _Heidi Xxx Xxxxxx Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _00 Xxxxxx Xx, Xxx X Title: Regional VP of Operations – East Division City/State/Zip: _Scarborough ME 04074 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _MD14388 Phone#: _0000000000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 1_/_5_/_2022 Date: 11/22/2021 | 11:44 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Maine Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Maine Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Maine Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Maine Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Maine Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Maine Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Maine Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Maine Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Maine Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Maine Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Maine Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Maine Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Maine Exhibit A-25 A-24 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 A-25 Zoster – Adults CDC Guidance (>50 60 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 A-26 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-27 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-28 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-29 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Treatment Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature:Xxxxx Xxxxxxxx D.O. Signature: Print Name: _Jason Torrente D.O. Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _4318 Route 130N Title: Regional VP of Operations – East Division City/State/Zip: Xxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: 25MB07308300 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: 000-000-0000 Date: _Dec 27, 2021 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 1/3/2022 | 11:14 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Jersey Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Jersey Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Jersey Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Print Name: _Charles Moehs Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _200 Xxxxxx St Title: Regional VP of Operations – East Division City/State/Zip: _Xxxxxxxxx XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _NY 104750 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 34, 2022 Date:1/4/2022 | 7:53 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateXxxxx Xxxxxxxx D.O. Signature: Signature: Print Name: Xxxxx Xxxxxxxx D.O. Print Name: Xxxxxxx Xxxxx, RPh, MS TitleAddress: 0000 Xxxxx 000X Xxxxx: Regional VP of Operations – East Division City/State/Zip: Xxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: 25MB07308300 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Dec 27, 2022 2021 Date: 1/3/2022 | 11:14 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Jersey Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Jersey Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Jersey Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: [Signature Page Follows] Signature: Print Name: Xxxxxxx _Elisa G Xxxxxxxx Address: _1181 Xxxx 000xx Xxx Xxxx/Xxxxx/Xxx: _Xxxxxxxx, RPhXX 00000 Signature: Print Name: Amr Elebiary, MS Pharm.D., MBA Title: Regional VP of Operations – East West Division Address: 000 X. Xxxxx Way, Suite 700 Authorizing Practitioner Signature: Genoa Healthcare, LLC: City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 SignatureDate: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 11/19/2021 | 9:37 AM PST Medical License#: _NY 224860 46156 Phone#: _000-000-0000 Date: _Jan 3, 2022 1/5/22 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Pharmacist Administered Vaccines
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Physician Signature: Xxxxxxx X. Xxxxxxxx, MD Signature: Signature: Print Name: _Xxxxxxx XxxxxXxxxxxxx Print Name: Xxxxxxx Xxxxxxx, RPh, MS RPh Address: _0000 Xxxxxxxx Xxxx Title: Regional VP of Operations – East South Division City/State/Zip: _Xxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _AL 25447 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 1/5/22 Date: 11/19/2021 | 2:31 PM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – - Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) )– Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – - Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) )– Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – - Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – - Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Alabama5 Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx 5 Per a telephone conversation with Xxxxx, a nurse with the Immunization Division (0-000-000-0000) Alabama Department of Public Health Immunization Division, Alabama will not allow pharmacists or pharmacies to hold the Yellow Fever stamp. (December 11, 2013) Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature Page Follows Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Practitioner Signature: Signature: Print Name: Xxxxxxx XxxxxAmr Elebiary, RPhPharm.D., MS MBA Title: Regional VP of Operations – East West Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 SignatureDate: 11/19/2021 | 9:37 AM PST Print Name: _Xxx Xx Xxxxx Xxxxxx Address: _000 Xxxxx Xxxxxx, Xxx 000 10301 Glacier Highway City/State/Zip: _Xxx XxxxJuneau, XX 00000 AK 99801 Medical License#: _NY 224860 AK5574 Phone#: _000-000-0000 Date: _Jan 3, 2022 1/5/22 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 12/2/2021 | 11:37 AM PST Date: Signature: Print Name: _Xxx Xx Annette Xxxxxx, MD Address: _000 Xxxxx Xxxxxx, Xx Xxx 000 CityXxxx/StateXxxxx/ZipXxx: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 MD440690 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Authorizing Physician: Genoa Healthcare, LLC: Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Pennsylvania Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Pennsylvania Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Pennsylvania Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Pennsylvania Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 SignatureDate:1/3/2022 | 11:14 AM PST 856-764-1483 Dec 27, 2021 Phone#: Date: Print Name: _Xxx Xx :Xxxxx Xxxxxxxx D.O. Address: _000 4318 Xxxxx Xxxxxx, Xxx 000 City000X Xxxx/StateXxxxx/ZipXxx: _Xxx XxxxXxxxxxxxxxx, XX 00000 Medical License#: _NY 224860 Phone#25MB07308300 Xxxxx Xxxxxxxx D.O. Signature: _000-000-0000 Date: _Jan 3, 2022 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Jersey Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Jersey Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Jersey Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Signature: Print Name: _zaheer shah Address: _65 Xxxxx Xxxxxxx Highway Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division City/State/Zip: _X. Xxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _RI MD 9877 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Dec 2, 2022 2021 Date: 12/13/2021 | 1:50 PM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Rhode Island Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Rhode Island Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Rhode Island Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Rhode Island Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Rhode Island Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Rhode Island Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Rhode Island Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Exhibit A-18 Pneumococcal Xxxxx Xxxxxx Xxxxxxx X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Rhode Island Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Rhode Island Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Rhode Island Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Rhode Island Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Rhode Island Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 60 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Physician Signature: Signature: Print Name: _Omolara Otaigbe Signature: Print Name: Xxxxxxx XxxxxXxxxxxx, RPhRPh Address: _0000 XX Xxxxxxx 00, MS Xxx X Title: Regional VP of Operations – East South Division City/State/Zip: _Xxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _MS 17878 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 1/5/22 Date: 11/29/2021 | 7:16 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Mississippi Pharmacists are not permitted to administer Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Signature: Print Name: _Zaid Xxxxx Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _One Hospital Plaza Title: Regional VP of Operations – East Division City/State/Zip: _Xxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _51568 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 2/5/22 Date: 11/19/2021 | 9:38 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Connecticut Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Connecticut Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Connecticut Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Connecticut Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Connecticut Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Connecticut Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Connecticut Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Connecticut Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Connecticut Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Connecticut Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Connecticut Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Connecticut Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Connecticut Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Not permitted by protocol in Connecticut Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Connecticut Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Connecticut Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Connecticut Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Connecticut Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Connecticut
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] Authorizing Physician Signature: Genoa Healthcare, LLC: 11/19/2021 | 2:31 PM PST Date: Signature: Print Name: Xxxxxxx Xxxxxxx, RPh Title: Regional VP of Operations – South Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxxxxx Xxxxx Address: _000 X Xxxxxxxx Xxxx Xxxx City/State/Zip: _Boca Raton, FL 33432 Medical License#: _ME 108693 Phone#: _000-000-0000 Date: _1/5/22 The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Florida. Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Florida. Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Florida. Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Florida. Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Florida. Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Florida. Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Florida. Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Florida. Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Florida. Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Florida. Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Florida. Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Florida. Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Florida. Exhibit A-25 A-24 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 A-25 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx japanese- encephalitis-standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx vaccine- standing-order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx fever- standing-order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Florida.
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Signature: Print Name: _John R Bogdasarian Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _00 Xxxxxxxx Xxxxxx, Xxx 000 Title: Regional VP of Operations – East Division City/State/Zip: _Xxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: MA 33995 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 1/5/22 Date: _Jan 3, 2022 Date: 11/19/2021 | 9:38 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis X-00 Xxxxxxx X-00 Xxxxxxxx Xxxxxxxxxxxx – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Massachusetts
Appears in 1 contract
Samples: Standing Order Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Signature: Print Name: _Xxxx X Xxxxxxxxxxx Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _00 Xxxxxxxx Xxxxxx, Xxx 000 Title: Regional VP of Operations – East Division City/State/Zip: _Xxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: MA 33995 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 1/5/22 Date: _Jan 3, 2022 Date: 11/19/2021 | 9:38 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis X-00 Xxxxxxx X-00 Xxxxxxxx Xxxxxxxxxxxx – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Massachusetts
Appears in 1 contract
Samples: Standing Order Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Xxxxxxx Xxxxxxx MD Signature: Print Name: _William Xxxxxxx XxxxxMD Print Name: Amr Elebiary, RPhPharm.D., MS MBA Address: _2412 Cuming St Title: Regional VP of Operations – East West Division City/State/Zip: _Xxxxx XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _NE 23544 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Pharmaceutical Care Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Practitioner Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateXxxxxx X. Xxxxxxxx, D.O. Signature: Signature: Print Name: Xxxxxxx Xxxxx_Andrew X. Xxxxxxxx, RPhD.O. Print Name: Amr Elebiary, MS Pharm.D., MBA Address: _000 X 00xx Xxxxxx Title: Regional VP of Operations – East West Division City/State/Zip: _Xxxxx Xxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _SD 5871 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Signature: Print Name: _xxxxxx xxxx Address: _65 Xxxxx Xxxxxxx Highway Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division City/State/Zip: _X. Xxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _RI MD 9877 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Dec 2, 2022 2021 Date: 12/13/2021 | 1:50 PM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Rhode Island Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Rhode Island Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Rhode Island Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Rhode Island Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Rhode Island Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Rhode Island Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Rhode Island Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Exhibit A-18 Pneumococcal Xxxxx Xxxxxx Xxxxxxx X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Rhode Island Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Rhode Island Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Rhode Island Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Rhode Island Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Rhode Island Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 60 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 12/14/2021 | 7:53 AM 1:55 PM PST Date: Signature: Print Name: Xxxxxxx XxxxxXxxxxxx, RPh, MS RPh Title: Regional VP of Operations – East South Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Xxxxxx Xxxxxx, MD, PhD Address: _000 Xxxxx Xxxxxx, 2000 Xxx 000 Xxxxxxx City/State/Zip: _Xxx XxxxXx. Xxxxx, XX 00000 Medical License#: _NY 224860 60215 Phone#: _000-000-0000 Date: _Jan 3Dec 14, 2022 2021 Authorizing Physician Signature: Genoa Healthcare, LLC: Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Georgia Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Georgia Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Georgia Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Georgia Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Georgia Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Georgia Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Georgia Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Georgia Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Georgia Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Georgia Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Georgia Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Georgia Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Georgia Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-32 A-27 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-28 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit X-00 XXXXX-00 Vaccines Moderna: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/moderna/downloads/standing-orders.pdf Pfizer-BioNTech: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/pfizer/downloads/standing-orders.pdf Xxxxxxx, Inc (Xxxxxxx & Xxxxxxx): xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/xxxxxxx/downloads/Xxxxxxx-Standing-Orders.pdf Attachment 1: Pharmacist Affidavit to Qualifications AFFIDAVIT OF STATE OF GEORGIA COUNTY OF Personally appeared before me, the undersigned officer who is duly authorized by law to administer oaths, , who, after first being sworn, states the following of (his/her) own personal knowledge:
Appears in 1 contract
Samples: Vaccine Protocol Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Xxxx Xxxxxx, MD Signature: Print Name: _Lane Xxxxxx, MD Print Name: Xxxxxxx Xxxxx, RPh, MS 000 Xxxxxxx Xxxxx Xx. Xxxxx 0 Address: Xxxxxxxx, XX 00000 City/State/Zip: Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _NH 11344 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 11:37 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol RPh may not administer in New York Hampshire Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 RPh may not administer in New Hampshire Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 11/22/2021 | 7:53 AM 12:12 PM PST Date: Signature: Print Name: Xxxxxxx XxxxxXxxxxxx, RPh, MS RPh Title: Regional VP of Operations – East South Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Xxxxx Xxxxxxxx Address: _000 Xxxxx Xxxxxx, Xxx 000 4219 Laclede Ave City/State/Zip: _Xxx XxxxXx. Xxxxx, XX 00000 Medical License#: _NY 224860 MO 0000000000 Phone#: _000-000-0000 Date: _Jan 3, 2022 1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Missouri Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Missouri Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-11 MMR – Children Not permitted by protocol in New York Missouri Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Missouri Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Missouri Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Missouri Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 11/22/2021 | 7:53 AM 12:12 PM PST Date: Signature: Print Name: Xxxxxxx XxxxxXxxxxxx, RPh, MS RPh Title: Regional VP of Operations – East South Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx David Xxxxxxxx Address: _000 Xxxxx Xxxxxx, Xxx 000 4219 Laclede Ave City/State/Zip: _Xxx XxxxXx. Xxxxx, XX 00000 Medical License#: _NY 224860 MO 0000000000 Phone#: _000-000-0000 Date: _Jan 3, 2022 1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Missouri Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Missouri Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-11 MMR – Children Not permitted by protocol in New York Missouri Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Missouri Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Missouri Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Missouri Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateXxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Xxxxxxx X Xxxxx, RPhMD Print Name: JxoxyxxHxoxlmxxaxnx, MS xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Title: Regional VP of Operations – East Midwest Division City/State/Zip: _Pickerington, OH 43147 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 60 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Jim Li Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Physician Signature: Signature:Xxxxx Xxxxxxxx D.O. Signature: Print Name: Xxxxx Xxxxxxxx D.O. Print Name: Xxxxxxx Xxxxx, RPh, MS TitleAddress: 0000 Xxxxx 000X Xxxxx: Regional VP of Operations – East Division Xxxxxxxxxxx, XX 00000 City/State/Zip: Address: 000 X. Xxxxx Way, Suite 700 Medical License#: 25MB07308300 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: 000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Dec 27, 2022 2021 Date: 1/3/2022 | 11:14 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Jersey Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Jersey Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Jersey Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Xxxxx Xxxxxxxx D.O. Signature: Print Name: Xxxxx Xxxxxxxx D.O. Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _4318 Route 130N Title: Regional VP of Operations – East Division City/State/Zip: _Xxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _25MB07308300 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Dec 27, 2022 2021 Date: 1/3/2022 | 11:14 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Jersey Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Jersey Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Jersey Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Mark Xxxxxxx Address: _000 Xxxxx Xxxxxxx Xxxxxx, Xxx xxxxx 000 CityXxxx/StateXxxxx/ZipXxx: _Xxx XxxxXxxxxx, XX 00000 Medical License#: _NY 224860 201382 Phone#: _000-000-0000 Date: _Jan 3Xxx 0, 2022 0000 Xxxxx Healthcare, LLC: Authorizing Physician Signature: Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Physician Signature: Signature: Print Name: _Xxxxxx X. Duclos Signature: Print Name: Xxxxxxx XxxxxXxxxxxx, RPh, MS RPh Address: _0000 Xxxx Xxxxxx Title: Regional VP of Operations – East South Division City/State/Zip: _Xxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _TN 53162 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 10:28 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Yellow Fever stamps are not provided to pharmacists or pharmacies Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Practitioner Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateXxxxxx X. Xxxxxxxx, D.O. Signature: Signature: Print Name: Xxxxxxx Xxxxx_Xxxxxx X. Burchett, RPhD.O. Print Name: Amr Elebiary, MS Pharm.D., MBA Address: _000 X 00xx Xxxxxx Title: Regional VP of Operations – East West Division City/State/Zip: _Xxxxx Xxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _SD 5871 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Physician Signature: Signature: Print Name: _Abigail XxXxxx DO Signature: Print Name: Xxxxxxx XxxxxXxxxxxx, RPhRPh Address: _000 Xxxxxx Xxxxxx Xxxx, MS Xxxxx X0 Title: Regional VP of Operations – East South Division City/State/Zip: _Bowling Xxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _03735 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 35, 2022 Date: 1/7/2022 | 7:50 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by KY pharmacists.4 Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 4 Per a December 20, 2013 telephone call with Xxxxxx Xxxxxx (Immunization Assessment Coordinator), for the Kentucky Cabinet for Health and Family Services, Department of Health at (000) 000-0000 x 0000 stated pharmacies or pharmacist can't apply for a yellow fever stamp, only a Kentucky licensed physician is allowed to be in possession of a yellow fever stamp.
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Xxxxxxx Xxxxxxx MD Signature: Print Name: Xxxxxxx Xxxxx_William Gossman MD Print Name: Xxx Xxxxxxxx, RPhPharm.D., MS MBA Address: _2412 Cuming St Title: Regional VP of Operations – East West Division City/State/Zip: _Xxxxx XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _NE 23544 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Pharmaceutical Care Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Practitioner Signature: Signature: Xxxxxx X Xxxxx MD Signature: Print Name: Xxxxxxx Xxxxx_Robert Xxxxx Print Name: Amr Elebiary, RPhPharm.D., MS MBA Address: _82 Chimney Rock Rd Title: Regional VP of Operations – East Division Xxxx Xxxxxxxx Xxxx/Xxxxx/Xxx: _Xxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _MN 43830 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 1/5/22 Date: 11/23/2021 | 8:10 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Protocol Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Physician Signature: Signature: Print Name: _Martin X. Xxxxxx Signature: Print Name: Xxxxxxx XxxxxXxxxxxx, RPh, MS RPh Address: _0000 Xxxx Xxxxxx Title: Regional VP of Operations – East South Division City/State/Zip: _Xxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _TN 53162 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 10:28 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Yellow Fever stamps are not provided to pharmacists or pharmacies Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Physician Signature: Xxxxxxx X. Xxxxxxxx, MD Signature: Signature: Print Name: _Michael Stanford Print Name: Xxxxxxx XxxxxXxxxxxx, RPh, MS RPh Address: _0000 Xxxxxxxx Xxxx Title: Regional VP of Operations – East South Division City/State/Zip: _Xxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _AL 25447 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 1/5/22 Date: 11/19/2021 | 2:31 PM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – - Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) )– Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – - Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) )– Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – - Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – - Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Alabama5 Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx 5 Per a telephone conversation with Xxxxx, a nurse with the Immunization Division (1-800-469-4599) Alabama Department of Public Health Immunization Division, Alabama will not allow pharmacists or pharmacies to hold the Yellow Fever stamp. (December 11, 2013) Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Physician Signature: Signature: Print Name: Xxxxx Xxxxx Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _0000 Xxxxxxx Xxxxxx Title: Regional VP of Operations – East Division City/State/Zip: _Xxxx, Xxx Xxxx 00000 Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 157143 Phone#: _000-000-0000 Date: _Jan 3, 2022 0000 Xxxx/Xxxxx/Xxx: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: 1/4/2022 | 7:53 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 Authorizing Physician Signature: 1/3/2022 | 7:53 11:14 AM PST Date: Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 SignatureDec 27, 2021 Date: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date25MB07308300 Medical License#: Signature: Xxxxx Xxxxxxxx D.O. Print Name:Xxxxx Xxxxxxxx D.O. Address: 0000 Xxxxx 000X Xxxx/Xxxxx/Xxx: _Jan 3Xxxxxxxxxxx, 2022 XX 00000 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Jersey Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Jersey Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Jersey Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Print Name: _Xxxxx Xxx Xxxxxx Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _00 Xxxxxx Xx, Xxx X Title: Regional VP of Operations – East Division City/State/Zip: _Scarborough ME 04074 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _MD14388 Phone#: _0000000000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 1_/_5_/_2022 Date: 11/22/2021 | 11:44 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Maine Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Maine Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Maine Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Maine Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Maine Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Maine Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Maine Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Maine Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Maine Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Maine Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Maine Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Maine Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Maine Exhibit A-25 A-24 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 A-25 Zoster – Adults CDC Guidance (>50 60 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 A-26 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-27 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-28 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-29 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Treatment Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature Page Follows Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateAuthorizing Practitioner Signature: Signature: Print Name: Xxxxxxx XxxxxAmr Elebiary, RPhPharm.D., MS MBA Title: Regional VP of Operations – East West Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 SignatureDate: 11/19/2021 | 9:37 AM PST Print Name: _Xxx Xx Laura Xxxxxx Address: _000 Xxxxx Xxxxxx, Xxx 000 10301 Glacier Highway City/State/Zip: _Xxx XxxxJuneau, XX 00000 AK 99801 Medical License#: _NY 224860 AK5574 Phone#: _000-000-0000 Date: _Jan 3, 2022 1/5/22 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Signature: Print Name: _Daniel B_auer Address: _000 Xxxxxxxx Xxx Print Name: Xxxxxxx XxxxxXxxxxxx, RPh, MS RPh Title: Regional VP of Operations – East South Division City/State/Zip: _Xxxxxxxxx XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _0000-0000 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Dec 13, 2022 2021 Date: 12/14/2021 | 1:55 PM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York North Carolina Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in North Carolina Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York North Carolina Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York North Carolina Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York North Carolina Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York North Carolina Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in North Carolina Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York North Carolina Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York North Carolina Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York North Carolina Exhibit A-18 Pneumococcal (PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York North Carolina Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York North Carolina Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York North Carolina Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York North Carolina Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York North Carolina Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in North Carolina Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit X-00 XXXXX-00 Vaccines Moderna: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/moderna/downloads/standing-orders.pdf Pfizer-BioNTech: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/pfizer/downloads/standing-orders.pdf Xxxxxxx, Inc (Xxxxxxx & Xxxxxxx): xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/xxxxxxx/downloads/Xxxxxxx-Standing-Orders.pdf Minimum Screening Questionnaire for Immunizing Pharmacists (Comments in italics are notes for use in applying questionnaire, but do not need to be present on patient copy to meet minimum standards.) Final version (8.30.13)
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateXxxxx Xxxxxxxx D.O. Signature: Signature: Print Name:Xxxxx Xxxxxxxx D.O. Print Name: Xxxxxxx Xxxxx, RPh, MS TitleAddress: 0000 Xxxxx 000X Xxxxx: Regional VP of Operations – East Division City/State/Zip: _Xxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _25MB07308300 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Dec 27, 2022 2021 Date: 1/3/2022 | 11:14 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Jersey Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Jersey Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Jersey Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] Authorizing Physician Signature: Genoa Healthcare, LLC: 11/19/2021 | 2:31 PM PST Date: Signature: Print Name: Xxxxxxx Xxxxxxx, RPh Title: Regional VP of Operations – South Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Cedric Xxxxx Address: _000 X Xxxxxxxx Xxxx Xxxx Xxxx/Xxxxx/Xxx: _Xxxx Xxxxx, XX 00000 Medical License#: _ME 108693 Phone#: _000-000-0000 Date: _1/5/22 The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3, 2022 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Florida. Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Florida. Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Florida. Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Florida. Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Florida. Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Florida. Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Florida. Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Florida. Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Florida. Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Florida. Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Florida. Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Florida. Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Florida. Exhibit A-25 A-24 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 A-25 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx japanese- encephalitis-standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx vaccine- standing-order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx fever- standing-order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Florida.
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateXxxxxxx X Xxxxx, MD Signature: Signature: Print Name: Xxxxxxx _Richard X Xxxxx, RPhMD Print Name: JxoxyxxHxoxlmxxaxnx, MS xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Title: Regional VP of Operations – East Midwest Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 60 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST Date: Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 12/2/2021 | 11:37 AM PST Date: Signature: Print Name: _Xxx Xx Xxxxxxx Xxxxxx, MD Address: _000 Xxxxx Xxxxxx, Xx Xxx 000 CityXxxx/StateXxxxx/ZipXxx: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 MD440690 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Authorizing Physician: Genoa Healthcare, LLC: Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Pennsylvania Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Pennsylvania Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Pennsylvania Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Pennsylvania Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Pennsylvania Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: 1/4/2022 | 7:53 AM PST DateSignature: Print Name: _H Xxxxxxx Xxxx MD Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Address: _000 Xxxxxxxx Xxxxx Title: Regional VP of Operations – East Division City/State/Zip: _Xxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _000.0000000 Phone#: _000-000-0000 City/State/Zip: RentonXxxxxx, WA 98057 XX 00000 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _NY 224860 Phone#: _000-000-0000 Date: _Jan 3Nov 30, 2022 2021 Date: 12/2/2021 | 11:37 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in New York Vermont Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Vermont Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children Not permitted by protocol in New York Vermont Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children Not permitted by protocol in New York Vermont Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in New York Vermont Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in New York Vermont Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children Not permitted by protocol in New York Vermont Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children Not permitted by protocol in New York Vermont Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children Not permitted by protocol in New York Vermont Exhibit A-18 Pneumococcal X-00 Xxxxxxxxxxxx (PPSV23 XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in New York Vermont Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in New York Vermont Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children Not permitted by protocol in New York Vermont Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children Not permitted by protocol in New York Vermont Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children Not permitted by protocol in New York Vermont Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Vermont
Appears in 1 contract
Samples: Collaborative Agreement
