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: 11/22/2021 | 12:12 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in 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 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 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 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 Missouri Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri Exhibit A-11 MMR – Children Not permitted by protocol in Missouri Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri Exhibit A-31 Yellow Fever – Children and Adults Not permitted by protocol in Missouri Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.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: 11/22/2021 | 12:12 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 Print Name: _Xxxxx David Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in 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 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 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 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 Missouri Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri Exhibit A-11 MMR – Children Not permitted by protocol in Missouri Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri Exhibit A-26 Zoster – Adults CDC Guidance (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri Exhibit A-31 Yellow Fever – Children and Adults Not permitted by protocol in Missouri Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.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: 11/22/2021 | 12:12 PM PST DateAuthorizing Physician Signature: Signature: Print Name: _Xxxxxx X. Duclos Signature: Print Name: Xxxxxxx Xxxxxxx, RPh Address: _0000 Xxxx Xxxxxx Title: Regional VP of Operations – 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureNov 30, 2021 Date: Exhibit A: Protocols 12/2/2021 | 10:28 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 | 12:12 PM PST DateSignature: Signature: Print Name: _Xxxx X Xxxxxxxxxxx Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS Address: _00 Xxxxxxxx Xxxxxx, Xxx 000 Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 1/5/22 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureDate: Exhibit A: Protocols 11/19/2021 | 9:38 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 Japanese Encephalitis A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit X-00 Xxxxxxx X-00 Xxxxxxxx Xxxxxxxxxxxx – Children and Adults Not permitted by protocol in Missouri Massachusetts Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri Massachusetts Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri Massachusetts Exhibit A-31 Yellow Fever – Children and Adults Not permitted by protocol in Missouri Massachusetts Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens Not 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: 11/22/2021 | 12:12 PM PST DateSignature: Xxxx Xxxxxx, MD Signature: Print Name: _Lane Xxxxxx, MD Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS 000 Xxxxxxx Xxxxx Xx. Xxxxx 0 Address: Xxxxxxxx, XX 00000 City/State/Zip: Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureNov 30, 2021 Date: Exhibit A: Protocols 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 Missouri New 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New 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 Missouri New Hampshire Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 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 Missouri New Hampshire Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New 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 Missouri New Hampshire Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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) RPh may not administer in New Hampshire Exhibit A-28 Japanese Encephalitis – Children and Adults Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-29 Rabies – Children and Adults Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-31 Yellow Fever – Children and Adults Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxxxx.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. [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: 11/22/2021 | 12:12 PM PST DateXxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Xxxxxxx XxxxxxxX Xxxxx, RPh MD Print Name: JxoxyxxHxoxlmxxaxnx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureNov 30, 2021 Date: Exhibit A: Protocols 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf Exhibit A-28 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 | 12:12 PM PST DateSignature: Print Name: _Heidi Xxx Xxxxxx Signature: Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS Address: _00 Xxxxxx Xx, Xxx X Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature1_/_5_/_2022 Date: Exhibit A: Protocols 11/22/2021 | 11:44 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in Missouri Maine Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri Maine Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri Maine Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri Maine Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in 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 Missouri Maine Exhibit A-25 A-24 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-26 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit 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: 11/22/2021 | 12:12 PM PST DateAuthorizing Physician Signature: Signature: Print Name: _Mark Xxxxxxx XxxxxxxSignature: Print Name: Xxxxxxx Xxxxx, RPh RPh, MS Address: _000 Xxxxxxx Xxxxxx, xxxxx 000 Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureJan 3, 2022 Date: Exhibit A: Protocols 1/4/2022 | 7:53 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 Missouri New York Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri New York Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 Missouri New York Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 | 12:12 PM PST DateSignature: Xxxxxxx Xxxxxxx MD Signature: Print Name: Xxxxxxx Xxxxxxx_William Gossman MD Print Name: Xxx Xxxxxxxx, RPh Pharm.D., MBA Address: _2412 Cuming St Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureNov 30, 2021 Date: Exhibit A: Protocols 12/2/2021 | 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-27 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-31 Medical Management of Vaccine Reactions in Missouri Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxChildren 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: 11/22/2021 | 12:12 PM PST DateXxxxx Xxxxxxxx D.O. Signature: Signature: Print Name:Xxxxx Xxxxxxxx D.O. Print Name: Xxxxxxx XxxxxxxXxxxx, RPh TitleRPh, MS Address: 0000 Xxxxx 000X Xxxxx: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureDec 27, 2021 Date: Exhibit A: Protocols 1/3/2022 | 11:14 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri New 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in Missouri New Jersey Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri New Jersey Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri New Jersey Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri New Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New 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 Missouri New Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 | 12:12 PM PST Date: [Signature Page Follows] Signature: Print Name: Xxxxxxx Xxxxxxx_Elisa G Xxxxxxxx Address: _1181 Xxxx 000xx Xxx Xxxx/Xxxxx/Xxx: _Xxxxxxxx, RPh XX 00000 Signature: Print Name: Amr Elebiary, Pharm.D., MBA Title: Regional VP of Operations – South 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 Print NameDate: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 11/19/2021 | 9:37 AM PST Medical License#: _MO 0000000000 46156 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 A-27 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-31 Medical Management of Vaccine Reactions in Missouri Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxChildren 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: 11/22/2021 1/4/2022 | 12:12 PM 7:53 AM PST Date: Signature: Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS Title: Regional VP of Operations – South East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxxxx Xxxxxxxx Mark Xxxxxxx Address: _4219 Laclede Ave City000 Xxxxxxx Xxxxxx, xxxxx 000 Xxxx/StateXxxxx/ZipXxx: _Xx. XxxxxXxxxxx, XX 00000 Medical License#: _MO 0000000000 NY 201382 Phone#: _000-000-0000 Date: _1/5/22 Xxx 0, 0000 Xxxxx Xxxxxxxx Healthcare, LLC: Authorizing Physician Signature: Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 Missouri New York Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri New York Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 Missouri New York Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 | 12:12 PM PST DateSignature: Signature: Print Name: _Zaid Xxxxx Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS Address: _One Hospital Plaza Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature2/5/22 Date: Exhibit A: Protocols 11/19/2021 | 9:38 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in Missouri Connecticut Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri Connecticut Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Connecticut Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri Connecticut Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri Connecticut Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Connecticut Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in 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 Missouri Connecticut Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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) Not permitted by protocol in Connecticut Exhibit A-28 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri Connecticut Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri Connecticut Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri Connecticut Exhibit A-31 Yellow Fever – Children and Adults Not permitted by protocol in Missouri Connecticut Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens Not 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. 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: 11/22/2021 | 12:12 PM PST DateXxxxxx X. Xxxxxxxx, D.O. Signature: Signature: Print Name: Xxxxxxx Xxxxxxx_Xxxxxx X. Burchett, RPh D.O. Print Name: Amr Elebiary, Pharm.D., MBA Address: _000 X 00xx Xxxxxx Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureNov 30, 2021 Date: Exhibit A: Protocols 12/2/2021 | 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 | 12:12 PM PST DateAuthorizing Physician Signature: Signature: Print Name: _Abigail XxXxxx DO Signature: Print Name: Xxxxxxx Xxxxxxx, RPh Address: _000 Xxxxxx Xxxxxx Xxxx, Xxxxx X0 Title: Regional VP of Operations – 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureJan 5, 2022 Date: Exhibit A: Protocols 1/7/2022 | 7:50 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri KY pharmacists.4 Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxxxx.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 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: 11/22/2021 | 12:12 PM PST DateSignature: Xxxxxxx Xxxxxxx MD Signature: Print Name: _William Xxxxxxx XxxxxxxMD Print Name: Amr Elebiary, RPh Pharm.D., MBA Address: _2412 Cuming St Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureNov 30, 2021 Date: Exhibit A: Protocols 12/2/2021 | 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-27 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-31 Medical Management of Vaccine Reactions in Missouri Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxChildren 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: 11/22/2021 | 12:12 PM PST DateAuthorizing Physician Signature: Xxxxxxx X. Xxxxxxxx, MD Signature: Signature: Print Name: _Xxxxxxx Xxxxxxxx Print Name: Xxxxxxx Xxxxxxx, RPh Address: _0000 Xxxxxxxx Xxxx Title: Regional VP of Operations – 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureDate: Exhibit A: Protocols 11/19/2021 | 2:31 PM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) )– Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) )– Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – - Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – - Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-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-28 Rabies - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit 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 Not permitted by protocol in Missouri Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri Alabama5 Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri Exhibit A-31 Yellow Fever – Children and Adults Not permitted by protocol in Missouri Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxxxx.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-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: 11/22/2021 | 12:12 PM PST DateAuthorizing Practitioner Signature: Signature: Print Name: Xxxxxxx XxxxxxxAmr Elebiary, RPh Pharm.D., MBA Title: Regional VP of Operations – South West Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Date: 11/19/2021 | 9:37 AM PST Print Name: _Xxxxx Xxxxxxxx Xxxxxx Address: _4219 Laclede Ave 10301 Glacier Highway City/State/Zip: _Xx. XxxxxJuneau, XX 00000 AK 99801 Medical License#: _MO 0000000000 AK5574 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 A-27 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-31 Medical Management of Vaccine Reactions in Missouri Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxChildren 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: 11/22/2021 | 12:12 PM PST Date: Signature: Print Name: Xxxxxxx XxxxxxxAmr Elebiary, RPh Pharm.D., MBA Title: Regional VP of Operations – South 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: _Xxxxx Xxxxxxxx Rushdi Alul Address: _4219 Laclede Ave City2233 Xxxx Xxxxxxxx Xxxxxx Xxxx/StateXxxxx/ZipXxx: _Xx. XxxxxXxxxxxx, XX 00000 Medical License#: _MO 0000000000 000.000000 Phone#: _000-000-0000 x0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols 1/10/22 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 A-27 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit 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: 11/22/2021 | 12:12 PM PST Date: Signature: Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS Title: Regional VP of Operations – South East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Date:1/3/2022 | 11:14 AM PST 856-764-1483 Dec 27, 2021 Phone#: Date: Print Name: _:Xxxxx Xxxxxxxx D.O. Address: _4219 Laclede Ave City4318 Xxxxx 000X Xxxx/StateXxxxx/ZipXxx: _Xx. XxxxxXxxxxxxxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 25MB07308300 Xxxxx Xxxxxxxx D.O. Signature: Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri New 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in Missouri New Jersey Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri New Jersey Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri New Jersey Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri New Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New 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 Missouri New Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 1/4/2022 | 12:12 PM 7:53 AM PST Date: Signature: Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS Title: Regional VP of Operations – South East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxxxx Xxxxxxxx Xxx Xx Address: _4219 Laclede Ave 000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xx. XxxxxXxx Xxxx, XX 00000 Medical License#: _MO 0000000000 NY 224860 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols Jan 3, 2022 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 Missouri New York Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri New York Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 Missouri New York Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 | 12:12 PM PST DateAuthorizing Physician Signature: Xxxxxxx X. Xxxxxxxx, MD Signature: Signature: Print Name: _Michael Stanford Print Name: Xxxxxxx Xxxxxxx, RPh Address: _0000 Xxxxxxxx Xxxx Title: Regional VP of Operations – 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureDate: Exhibit A: Protocols 11/19/2021 | 2:31 PM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) )– Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) )– Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – - Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – - Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-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-28 Rabies - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit 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 Not permitted by protocol in Missouri Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri Alabama5 Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri Exhibit A-31 Yellow Fever – Children and Adults Not permitted by protocol in Missouri Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxxxx.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-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: 11/22/2021 | 12:12 PM PST DateAuthorizing Physician Signature: Signature: Print Name: _Omolara Otaigbe Signature: Print Name: Xxxxxxx Xxxxxxx, RPh Address: _0000 XX Xxxxxxx 00, Xxx X Title: Regional VP of Operations – 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureDate: Exhibit A: Protocols 11/29/2021 | 7:16 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-27 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not Mississippi Pharmacists are not permitted by protocol in Missouri to administer Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit 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: 11/22/2021 | 12:12 PM PST DateSignature: Print Name: _STEVEN XXXXXXXXXX Signature: Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS Address: _00 Xxxxxxxxx Xxxxxx Xxxx Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols 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 Missouri 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 Missouri New York Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri New York Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri New York Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 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 Missouri New York Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 | 12:12 PM PST DateAuthorizing Physician Signature: Signature: Print Name: _Martin X. Xxxxxx Signature: Print Name: Xxxxxxx Xxxxxxx, RPh Address: _0000 Xxxx Xxxxxx Title: Regional VP of Operations – 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureNov 30, 2021 Date: Exhibit A: Protocols 12/2/2021 | 10:28 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 | 12:12 PM PST DateXxxxx Xxxxxx Signature: Signature: _ Print Name: Xxxxxxx Xxxxxxx_Peter Shalit Print Name: Amr Elebiary, RPh Pharm.D., MBA Address: _000 Xxxxx Xxxxxx, Suite 850 Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureJan 19, 2022 Date: Exhibit A: Protocols 1/19/2022 | 9:03 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 A-27 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-31 Medical Management of Vaccine Reactions in Missouri Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxChildren 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: 11/22/2021 | 12:12 PM PST DateAuthorizing Practitioner Signature: Signature: Xxxxxx X Xxxxx MD Signature: Print Name: Xxxxxxx Xxxxxxx_Robert Xxxxx Print Name: Amr Elebiary, RPh Pharm.D., MBA Address: _82 Chimney Rock Rd Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureDate: Exhibit A: Protocols 11/23/2021 | 8:10 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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. [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: 11/22/2021 | 12:12 PM PST DateXxxxxxx X Xxxxx, MD Signature: Signature: Print Name: Xxxxxxx Xxxxxxx_Richard X Xxxxx, RPh MD Print Name: JxoxyxxHxoxlmxxaxnx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureNov 30, 2021 Date: Exhibit A: Protocols 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf Exhibit A-28 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 | 12:12 PM PST DateSignature: Signature: Print Name: _John R Bogdasarian Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS Address: _00 Xxxxxxxx Xxxxxx, Xxx 000 Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 1/5/22 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureDate: Exhibit A: Protocols 11/19/2021 | 9:38 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 Japanese Encephalitis A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit X-00 Xxxxxxx X-00 Xxxxxxxx Xxxxxxxxxxxx – Children and Adults Not permitted by protocol in Missouri Massachusetts Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri Massachusetts Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri Massachusetts Exhibit A-31 Yellow Fever – Children and Adults Not permitted by protocol in Missouri Massachusetts Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens Not 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: 11/22/2021 | 12:12 PM PST DateSignature: Print Name: _Xxxxx Xxx Xxxxxx Signature: Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS Address: _00 Xxxxxx Xx, Xxx X Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature1_/_5_/_2022 Date: Exhibit A: Protocols 11/22/2021 | 11:44 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in Missouri Maine Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri Maine Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri Maine Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri Maine Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in 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 Missouri Maine Exhibit A-25 A-24 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 A-27 Zoster – Adults FDA Labeling (>50 yr) See Exhibit A-26 Exhibit A-26 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit 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: 11/22/2021 Authorizing Physician Signature: 1/3/2022 | 12:12 PM 11:14 AM PST Date: Signature: Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS Title: Regional VP of Operations – South East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Print NameDec 27, 2021 Date: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 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: _1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols Xxxxxxxxxxx, XX 00000 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri New 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children Not permitted by protocol in Missouri New Jersey Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri New Jersey Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri New Jersey Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri New Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New 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 Missouri New Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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 Page Follows Signature: Genoa Healthcare, LLC: 11/22/2021 | 12:12 PM PST DateAuthorizing Practitioner Signature: Signature: Print Name: Xxxxxxx XxxxxxxAmr Elebiary, RPh Pharm.D., MBA Title: Regional VP of Operations – South West Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Date: 11/19/2021 | 9:37 AM PST Print Name: _Xxxxx Xxxxxxxx Laura Xxxxxx Address: _4219 Laclede Ave 10301 Glacier Highway City/State/Zip: _Xx. XxxxxJuneau, XX 00000 AK 99801 Medical License#: _MO 0000000000 AK5574 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 A-27 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-31 Medical Management of Vaccine Reactions in Missouri Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxChildren 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: 11/22/2021 | 12:12 PM PST DateXxxxxx Xxxxxxxx Signature: Signature: Print Name: Xxxxxxx Xxxxxxx_Daniel Xxxxxxxx Print Name: Amr Elebiary, RPh Pharm.D., MBA Address: _S7563 Xxxxx Xx Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureNov 30, 2021 Date: Exhibit A: Protocols 12/2/2021 | 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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: 11/22/2021 | 12:12 PM PST DateSignature: Xxxx Xxxxxx, MD Signature: Print Name: _Lane Beatty, MD Print Name: Xxxxxxx XxxxxxxXxxxx, RPh RPh, MS 000 Xxxxxxx Xxxxx Xx. Xxxxx 0 Address: Xxxxxxxx, XX 00000 City/State/Zip: Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureNov 30, 2021 Date: Exhibit A: Protocols 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 Missouri New 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 Not permitted by protocol in Missouri 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New 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 Missouri New Hampshire Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 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 Missouri New Hampshire Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New 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 Missouri New Hampshire Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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) RPh may not administer in New Hampshire Exhibit A-28 Japanese Encephalitis – Children and Adults Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-29 Rabies – Children and Adults Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-31 Yellow Fever – Children and Adults Not permitted by protocol RPh may not administer in Missouri New Hampshire Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxxxx.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: 11/22/2021 | 12:12 PM PST Date: [Signature Page Follows] Signature: Print Name: Xxxxxxx Xxxxxxx_Xxxxx X Xxxxxxxx Address: _1181 Xxxx 000xx Xxx Xxxx/Xxxxx/Xxx: _Xxxxxxxx, RPh XX 00000 Signature: Print Name: Amr Elebiary, Pharm.D., MBA Title: Regional VP of Operations – South 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 Print NameDate: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 11/19/2021 | 9:37 AM PST Medical License#: _MO 0000000000 46156 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx Signature: Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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-28 A-27 Japanese Encephalitis – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 Not permitted by protocol xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-31 Medical Management of Vaccine Reactions in Missouri Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxxChildren 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 Practitioner Signature: Genoa Healthcare, LLC: 11/22/2021 | 12:12 PM PST DateXxxxxx X. Xxxxxxxx, D.O. Signature: Signature: Print Name: Xxxxxxx Xxxxxxx_Andrew X. Xxxxxxxx, RPh D.O. Print Name: Amr Elebiary, Pharm.D., MBA Address: _000 X 00xx Xxxxxx Title: Regional VP of Operations – South 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 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _MO 0000000000 Phone#: _000-000-0000 Date: _1/5/22 Xxxxx Xxxxxxxx SignatureNov 30, 2021 Date: Exhibit A: Protocols 12/2/2021 | 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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 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 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children 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 xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children Not permitted by protocol in Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children 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 Missouri xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults Not permitted by protocol in Missouri xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults Not permitted by protocol in Missouri 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 Not permitted by protocol in Missouri 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.xxxxxx.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
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Samples: Collaborative Agreement
