EXHIBIT 10.28
PHARMACY DISPENSING SERVICES AGREEMENT
BY AND BETWEEN
------------------------------------,
D/B/A/ NEIGHBORCARE
AND
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PHARMACY DISPENSING SERVICES AGREEMENT
This Pharmacy Dispensing Services Agreement ("Agreement") is made and
entered into as of the______________________ , by and between
_____________________, d/b/a NeighborCare, a ___________corporation
("NEIGHBORCARE"), and _____________________, a __________ corporation doing
business as _____________________________________, solely in connection with the
facility located at ______________________________________________("Facility").
RECITALS
WHEREAS, the Facility is engaged in the operation of a nursing
facility;
WHEREAS, NEIGHBORCARE is a licensed pharmacy in the State of
_______________ and is in the business of selling and supplying prescription and
nonprescription pharmaceutical products ("Pharmacy Products") to residents of
nursing, assisted living and other long-term care facilities; and
WHEREAS, the parties hereto desire to enter into this Agreement with
respect to the provision of Pharmacy Products identified on Exhibit A hereto and
as set forth herein by NEIGHBORCARE to the Facility and to the residents of the
Facility ("Residents");
NOW, THEREFORE, for and in consideration of the foregoing recitals and
of the mutual promises contained in this Agreement the parties hereto hereby
agree as follows:
ARTICLE I
REPRESENTATIONS AND WARRANTIES OF NEIGHBORCARE
1.1 Necessary Licenses and Qualifications. NEIGHBORCARE represents and
warrants that it has and shall maintain for the term hereof all
necessary qualifications, certificates, approvals, permits and licenses
required pursuant to applicable federal, state and local laws and
regulations to provide the Pharmacy Products under this Agreement.
1.2 Authority. NEIGHBORCARE represents and warrants that it has all
necessary power and authority to execute, deliver and perform this
Agreement.
ARTICLE II
REPRESENTATIONS AND WARRANTIES OF FACILITY
2.1 Necessary Licenses and Qualifications. Facility represents and warrants
that it has and shall maintain for the term hereof all necessary
qualifications, certificates, approvals, permits and licenses required
pursuant to applicable federal, state and local laws and regulations to
operate the Facility.
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2.2 Authority. Facility represents and warrants that it has all necessary
power and authority to execute, deliver and perform this Agreement with
respect to the Facility.
2.3 Professional Management Responsibility. Facility hereby represents and
warrants that it retains professional management responsibility over
all services furnished hereunder, and retains all management and
administrative rights and responsibilities normally assumed by the
operator of a nursing facility.
ARTICLE III
NEIGHBORCARE SERVICES
NEIGHBORCARE shall provide the Pharmacy Products set forth in this
Article III and as further described in Exhibit A and its Appendices which are
attached hereto and made a part hereof, to the Facility in compliance with the
standards set forth herein and as may be otherwise required by applicable law.
3.1 Pharmacy Products.
(a) Upon the prescribing physician's or Facility's, as the case
may be, order, NEIGHBORCARE agrees to deliver promptly
prescription and non-prescription drugs and supplies within
reasonable times to the Facility. If, for any reason,
NEIGHBORCARE is unable to deliver requested item(s) within a
reasonable time, then NEIGHBORCARE shall promptly notify the
Facility of its inability to so deliver. NEIGHBORCARE will, at
all times, use its best efforts to secure and deliver all
ordered drugs and supplies. In the event that the item ordered
is not available, NEIGHBORCARE will use its best efforts to
contact the prescribing physician to determine whether an
alternate item might be prescribed.
(b) NEIGHBORCARE will provide the Facility with an appropriate
number of stat medication kits and a use policy which shall
conform to all applicable rules and regulations. It is further
understood and agreed by both parties that use of an item from
such kit shall be pursuant only to a drug order by a licensed
physician. Facility agrees to promptly report to NEIGHBORCARE
the usage of any item from the stat medication kit to
facilitate the billing for said items to the appropriate
Resident. In the event that Facility fails to report such
usage, the cost of replenishing the stat medication kit to the
approved list of contents shall be borne by Facility.
3.2 Pharmacy Consulting Services. This Agreement does not include the
provision of pharmacy consulting services as required under the
conditions of participation in the Medicare and Medicaid programs for
nursing facilities. The provision of those services on a consultant or
advisory basis shall be provided under and covered exclusively by a
separate agreement.
3.3 NEIGHBORCARE General Service Requirements.
(a) NEIGHBORCARE agrees to provide all Pharmacy Products pursuant
to the terms of this Agreement Monday through Friday during
normal business hours and shall
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provide on-call services twenty-four (24) hours per day, seven
(7) days per week throughout the calendar year.
(b) NEIGHBORCARE shall institute purchase order, invoice and
product shipment procedures to facilitate efficient and timely
ordering and delivery of Pharmacy Products for use in
connection with Residents. NEIGHBORCARE shall arrange for the
delivery of Pharmacy Products at such time or times as are
appropriate to facilitate their use in the treatment of
Residents for whom the Pharmacy Products are ordered.
(c) NEIGHBORCARE shall provide to the Facility all forms
NEIGHBORCARE deems necessary for the proper execution of the
Pharmacy Supply delivery system. Such forms include, but shall
not be limited to, drug order and re-order forms, delivery
receipt forms and communication orders.
(d) As permitted by applicable law, NEIGHBORCARE shall, from time
to time, make available to the Facility certain materials and
equipment necessary or appropriate for the ordering and
provision of the Pharmacy Products provided hereunder. The
materials and equipment so provided may include, without
limitation and as mutually agreed by the parties hereto, stat
medication kits, medication carts and drug delivery systems,
telecommunications equipment, reference books, films, slides,
manuals and audio-visual equipment and training aids. It is
understood and agreed to by Facility that all such items of
material and equipment shall at all times remain the property
of NEIGHBORCARE and upon demand by NEIGHBORCARE shall be
returned to NEIGHBORCARE in their original condition subject
to normal wear and tear. Facility shall cause all such items
to be used solely in connection with the ordering or provision
of Pharmacy Products hereunder.
ARTICLE IV
FACILITY OBLIGATIONS WITH RESPECT TO SERVICES
In connection with the ordering and receipt of the Pharmacy Products
set forth in Article III, Facility agrees that:
4.1 Resident Status. The Facility will notify NEIGHBORCARE as to the status
of each Resident regarding source of reimbursement for Pharmacy
Products and shall promptly notify NEIGHBORCARE as to changes of
reimbursement. Notification shall include the provision to NEIGHBORCARE
of copies of Medicare, Medicaid and insurance coverage cards.
4.2 Physician Orders. The Facility shall promptly notify NEIGHBORCARE
regarding the physician order for Pharmacy Products, including any
physician change orders.
4.3 Use of Material and Equipment Provided by NEIGHBORCARE. Facility shall
be liable for, and shall indemnify and defend NEIGHBORCARE from and
against, any and all damages, costs, liabilities, expenses and losses,
including, without limitation, the cost of repairs or replacement,
whatsoever sustained or incurred as a result of casualty to or loss of,
or the misuse or otherwise improper use of, any and all material and
equipment
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provided by NEIGHBORCARE for the use of Facility in connection with the
provision of Pharmacy Products pursuant to the terms hereof.
ARTICLE V
BILLING AND PAYMENT
5.1 Billing and Payment for Pharmacy Products.
(a) The payment rates applicable to the Pharmacy Products provided
hereunder shall be as set forth in Exhibit A and its
Appendices attached hereto and made a part hereof.
(b) Except as provided to the contrary in Section 5.1(c) below,
NEIGHBORCARE shall ▇▇▇▇ Residents and third party payors with
respect to Residents, as appropriate, for all Pharmacy
Products provided by NEIGHBORCARE to Residents under this
Agreement. Other than as expressly provided for herein to the
contrary, Facility shall have no obligation to pay
NEIGHBORCARE or liability to NEIGHBORCARE in connection
therewith with respect to any and all amounts that may be
billed by NEIGHBORCARE directly to third party payors or
Residents pursuant to applicable law.
(c) NEIGHBORCARE shall ▇▇▇▇ Facility, and Facility shall be liable
for payment, with respect to all Pharmacy Products provided to
Residents:
(1) for whom coverage is provided under Medicare Part A
at the time the Pharmacy Products are provided
hereunder;
(2) for whom coverage is provided under Medicare Part B
consolidated billing requirements in effect at the
time the Pharmacy Products are provided hereunder;
(3) for whom coverage is provided under Medicaid payment
to Facility covering the Pharmacy Products provided
hereunder, or where applicable federal or state law
precludes direct billing by NEIGHBORCARE of the
Medicaid agency or the Resident;
(4) for whom payment is made by a third party payor to
Facility pursuant to the terms of a contract
governing payment for the Pharmacy Products provided
hereunder.
5.2 Monthly Billing and Payment. NEIGHBORCARE shall ▇▇▇▇ Facility on a
monthly basis by the fifth (5th) working day of each month for Facility
charges incurred during the past month. Facility shall pay NEIGHBORCARE
within thirty (30) days of receipt of an invoice from NEIGHBORCARE. All
amounts past due by more than thirty (30) days shall bear interest at
the rate of one and one-half percent (1.5%) per month, or the maximum
monthly rate of interest permitted by applicable law, whichever is
less.
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ARTICLE VI
TERM AND TERMINATION
6.1 Term. The initial term of this Agreement shall commence on the
Effective Date (as defined in the Settlement Agreement re Pharmacy
Supply Contracts dated August ___, 2001) and will continue in full
force and effect for eighteen months. Thereafter, this Agreement shall
automatically renew for successive one (1) year terms, and during any
such renewal term either party shall have the right to terminate this
Agreement without cause by providing to the other party not less than
sixty (60) days prior written notice of termination.
6.2 Termination.
(a) This Agreement shall automatically terminate with respect to
the Facility upon the revocation or cancellation of the
Facility's license or certification.
(b) Upon the suspension of the Facility's license or
certification, NEIGHBORCARE shall have the right to terminate
this Agreement immediately upon written notice to Facility.
(c) If either party should materially fail to fulfill its
obligations or conditions set forth herein and such default
shall not be cured within thirty (30) days after written
notice from the other party specifying the nature of default,
the aggrieved party shall have the right to terminate this
Agreement by giving written notice of termination to the
defaulting party, and this Agreement shall terminate on the
thirtieth (30th) day after such notice is given. Either party
shall have the right to cure any such default up to, but not
after, the giving of such notice of termination.
(d) This Agreement may be terminated pursuant to the terms of
Section 8.10(b).
ARTICLE VII
RECORDS
7.1 Patient Records. NEIGHBORCARE shall maintain accurate patient records,
adequate to meet the needs of various sources of payment for patient
services (payors) from which the Facility may submit bills and expect
payments. Records shall be maintained of the Pharmacy Products supplied
to each Resident, in accordance with the directions for the Resident's
attending physician and the Facility. Notwithstanding the foregoing,
the production of medical records shall remain the responsibility of
the Facility.
7.2 Government Access to Records. NEIGHBORCARE and its subcontractors shall
make available, upon written request from the Secretary of the U.S.
Department of Health and Human Services, or the Comptroller General of
the United States General Accounting Office, or any of their duly
authorized representatives, this Agreement, and the books, documents
and records of NEIGHBORCARE that are necessary to verify the extent of
costs incurred by Facility with respect to providing services under
this Agreement for four (4) years thereafter the provision of such
services.
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7.3 NEIGHBORCARE Access to Records.
(a) The Facility shall give NEIGHBORCARE reasonable access to all
resident records, facilities and supplies necessary for the
performance of its duties herein.
(b) In the event of any dispute arising from any claim or ▇▇▇▇
submitted by NEIGHBORCARE, Facility shall give NEIGHBORCARE
access to all reasonable and necessary documents and records
to investigate the accuracy of the claim. Such access shall be
during normal business hours following reasonable advance
notice from NEIGHBORCARE.
ARTICLE VIII
MISCELLANEOUS
8.1 Exclusivity. NEIGHBORCARE shall be the sole and exclusive provider of
Pharmacy Products to Facility and its Resident[s] during the term of
this Agreement, unless otherwise required by law. Notwithstanding the
foregoing, Facility agrees to cause any other providers of similar
Pharmacy Products to utilize any systems and to comply with any
policies and procedures relating to the provision of Pharmacy Products
in order to insure the efficient administration of such systems,
policies and procedures.
8.2 Independent Contractors. In the performance by each party hereto of
their respective obligations hereunder, the parties shall at all times
hereunder be deemed to be independent contractors, and not the agent of
the other. Except to the extent expressly provided for herein to the
contrary, neither party shall have the right or power to bind the
other.
8.3 Insurance.
(a) NEIGHBORCARE shall maintain, during the term of this
Agreement, liability insurance coverage for its acts and
omissions in amounts of no less than one million dollars per
claim and three million dollars annual aggregate. Prior to the
commencement of this Agreement, NEIGHBORCARE shall provide to
Facility a certificate of insurance indicating that such
coverage is in effect and providing that Facility will be
notified at least thirty (30) days prior to any modification,
cancellation, reduction or non-renewal of such coverage. Any
substantial change in coverage that might adversely affect or
actually materially adversely affects Facility shall be a
breach of this Agreement.
(b) Facility shall maintain, during the term of this Agreement,
liability insurance coverage for its acts and omissions in
amounts of no less than one million dollars per claim and
three million dollars annual aggregate. Prior to the
commencement of this Agreement, Facility shall provide to
NEIGHBORCARE a certificate of insurance indicating that such
coverage is in effect and providing that NEIGHBORCARE will be
notified at least thirty (30) days prior to any modification,
cancellation, reduction or non-renewal of such coverage. Any
substantial change in coverage that might adversely affect or
actually materially adversely affects NEIGHBORCARE shall be a
breach of this Agreement.
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8.4 Indemnification.
(a) Facility shall defend, indemnify, protect and hold harmless
NEIGHBORCARE and its affiliates, and the officers, directors,
employees and agents of each of them, from and against any and
all liability, obligation, damage, loss, cost, claim,
judgment, settlement, expense or demand whatsoever, of any
kind or nature, including reasonable attorneys fees and
defense costs in connection therewith, arising directly or
indirectly from actions taken or omissions made by Facility in
its performance under this Agreement.
(b) NEIGHBORCARE shall defend, indemnify, protect and hold
harmless Facility and its affiliates, and the officers,
directors, employees and agents of each of them, from and
against any and all liability, obligation, damage, loss, cost,
claim, judgment, settlement, expense or demand whatsoever, of
any kind or nature, including reasonable attorneys fees and
defense costs in connection therewith, arising directly or
indirectly from actions taken or omissions made by
NEIGHBORCARE or its affiliates in its performance under this
Agreement.
(c) Section 8.4 will survive termination of this Agreement and
completion of the parties' duties under this Agreement.
8.5 Governing Law. Disputes arising under this Agreement shall be governed
according to the internal laws of the state of the location of the
Facility, without regard to the conflicts of laws provisions thereof.
8.6 Compliance with Applicable Law. In all aspects relative to the
performance of their respective obligations under this Agreement, both
parties shall conduct their respective businesses in accordance with
applicable law.
8.7 Successors and Assigns. This Agreement shall be binding upon either
party's purchasers, transferees, successors and assigns, whether by
operation of law or otherwise, including but not limited to the sale of
the stock, assets or any other ownership interest of a party hereto to
another, or the merger or consolidation of a party hereto into another,
or any transaction by which a party to this Agreement transfers its
business to another as to which the duties and obligations provided for
under this Agreement by either or both parties hereto arise.
8.8 Waiver of Breach. The waiver of any breach of this Agreement by either
party shall not constitute a continuing waiver or a waiver of any
subsequent breach of either the same or any other provision of this
Agreement.
8.9 Notices. Any notice or other communication made or contemplated to be
made under this Agreement shall be in writing and shall be deemed to
have been received by the party to whom it is addressed on the date of
delivery, if delivered by hand, or three (3) business days after it is
deposited in the United States Mail, postage prepaid, return receipt
requested, or the next business day after it is transmitted by Federal
Express or similar overnight delivery services, addressed, in the case
of NEIGHBORCARE to:
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NeighborCare
▇ ▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇
Attn: President
with a copy to:
NeighborCare
▇▇▇ ▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇
▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇
Attn: Law Department
and in the case of Facility to:
-----------------------------------
-----------------------------------
-----------------------------------
Attn: Administrator
Either party may change its address for notices given hereunder by
giving fifteen (15) days prior written notice in accordance with this
Section 8.9.
8.10 Entire Agreement; Amendments.
(a) This Agreement, together with all Exhibits hereto, which are
incorporated herein and made a part hereof by this reference,
constitutes the entire Agreement between the parties hereto
and supersedes and cancels any other prior agreements or
understandings whether written, oral or implied. This
Agreement may not be amended except by an instrument in
writing signed by both the parties hereto.
(b) In the event of any material change in statutes, regulations,
or enforceable governmental policies applicable to either
party's obligations arising under this Agreement, or in the
event of the severance of any provision hereof pursuant to
Section 8.11, and either party is materially and adversely
affected thereby so as to materially diminish the benefits of
this Agreement reasonably intended by such affected party,
such affected party may provide notice of such material
adverse effect to the other, and request that this Agreement
be amended to resolve such material adverse effect. The
parties shall then be obligated to engage in good faith
negotiations in an attempt to agree upon an acceptable
amendment to this Agreement for the purpose of resolving the
material adverse effect. If the parties fail to agree to amend
this Agreement within thirty (30) days after receipt of notice
of material adverse effect, the affected party may terminate
this Agreement at any time thereafter, upon notice given to
the other party.
8.11 Severability. The invalidity or unenforceability of any term or
provision hereof shall not affect the validity or enforceability of any
other term or provision hereof.
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8.12 Section Headings. The section headings contained in this Agreement are
for reference purposes only and shall not affect the construction of
this Agreement.
8.13 Nondiscrimination. NEIGHBORCARE shall provide all Pharmacy Products and
otherwise perform all of its duties and responsibilities hereunder
without unlawful discrimination on the basis of race, color, religion,
national origin, sex ancestry, disability or any other basis protected
by law.
[SIGNATURE PAGE FOLLOWS]
* * *
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IN WITNESS WHEREOF, the parties have executed this Agreement in
multiple counterparts, each of which shall be deemed to be an original, and all
of which together shall constitute this Agreement, effective as of the date
first written above.
NEIGHBORCARE:
By:
-------------------------------
Its: Sr. Vice President
Date: , 2001
FACILITY:
----------------------------------
By:
-------------------------------
Its: Vice President
Date: , 2001
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Exhibit A
PAYMENT RATES FOR PHARMACY PRODUCTS
Pricing/Basic Rates
- NEIGHBORCARE will charge Facility the prevailing Medicaid rate in the
respective state.
Scope:
- Basic rate will be effective for ALL prescription medications for which
NEIGHBORCARE looks to the Facility for payment. This includes but may
not necessarily be limited to private patients, HMO or managed care
patients, PBM patients, and Medicare Part A patients.
- All payor sources except Medicaid or any other party which NEIGHBORCARE
will ▇▇▇▇ direct.
Medicaid Rates by State (from National Pharmaceutical Council)
California AWP -5% + 3.85
Colorado AWP -10% + 4.08
Illinois* AWP -11% + 4.00
Michigan AWP -15.0% +3.72
South Carolina AWP -10% + 4.05
Wisconsin AWP -10% + 4.88
*Note: Average of various formula charges. See Appendix "A."
OVER THE COUNTER (OTC)
(NON-PRESCRIPTION MEDICATIONS)
Pricing/Basic Rates
- NEIGHBORCARE is not the preferred provider for Facility for
non-prescription, OTC, floor stock medications.
- NEIGHBORCARE will charge AWP x 1.3 for all OTC items ordered by
Facility for nonprescription needs.
- NEIGHBORCARE will fill all OTC, floor stock orders at the above
pricing.
- Any OTC packaged patient specific should be priced the same as other
prescription orders (i.e. Medicaid formula).
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APPENDIX "A"
STATE MEDICAID CHARGE DETAIL
ILLINOIS
ILLINOIS:
VARIABLE FEE SCHEDULE
If AWP is $0 to $3.58 then variable fee is $3.58.
If AWP is $3.59 to $14.99 then variable fee is equal to AWP.
If AWP is $15.00 or more then variable fee is $15.00.
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Exhibit A continued
I.V. THERAPY
(INTRAVENOUS THERAPY PRODUCTS AND SERVICES)
Pricing/Basic Charge (Products and Pumps)
- Medications and solutions -- AWP x 0.9 + $30 per diem for each therapy
plus $5 for each additional dose
- Ancillary supplies will be included as detailed in Appendix "A";
additional supplies will be invoiced at acquisition cost x 1.25.
- I.V. electronic pumps:
- Stationary $5.00/day
- Ambulatory $7.00/day
- Elastomeric $8.00/dose
Pricing/Basic Charge (Support Services)
- NEIGHBORCARE will provide support and I.V. education services as
requested and will charge according to the fee schedule in
Appendix "B".
Total Parenteral Nutrition (TPN) Pricing
- Pricing does include charges for pump rental.
- Pricing does not include Vascular Access for product delivery. The
charges for those services will be consistent with the contracted price
for the Customer.
- There are two price tiers based on grams of protein for the final
solution:
Tier I: Standard TPN solution without lipids for 1,000 cc.$110/day
▇▇-▇▇▇ ▇▇▇▇▇ ▇▇ ▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇, ▇▇, ▇▇▇: (with Lipids
$120/day)
Tier II: For TPN solutions in excess of 120 grams of $140/day
protein the pricing formula is: (with Lipids
$150/day)
IV Hydration Pricing
- Standard Hydration Solution 1.0 liter per day = $15 ($8 each additional
liter)
- Additives for any therapy will be billed at AWP x 0.9 of the drug.
Base IV Solution Pricing
- Base solutions billed at AWP x 0.9
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APPENDIX "A"
IV Supplies included by Therapy
STANDARD IV ANCILLARY SUPPLY UTILIZATION
HYDRATION - CONTINUOUS INFUSION (PERIPHERAL)
Item Description # Units / per # days
---------------- -----------------------
IV Tubing 1 2-3 days
IV Pump 1 per therapy duration
IV Start Kit 1 2 days
IV Catheter 2 2 days
IV Securement device 1 2 days
IV Flush supplies (Pre-filled, vials as extra) 1 2 days
IV Needleless system supplies PRN
HYDRATION - CONTINUOUS INFUSION (CENTRAL)
Item Description # Units / per # days
----------------- -----------------------
IV Tubing 1 2-3 days
IV Pump 1 per therapy duration
Central Line Drsg change kit 1 7
IV Securement Device 1 7
IV Flush supplies (Pre-filled, vials as extra) 1 7 or prn
IV Needleless system supplies PRN
TOTAL PARENTERAL NUTRITION - CONTINUOUS
Item Description # Units / per # days
----------------- -----------------------
IV Tubing with appropriate filter 1 1
(.22 vs. 1.2 micron)
IV Pump 1 per tx. Duration
Central Line Dressing Change Kit 1 7
IV securement device 1 7
0.9 NaCl multi-dose vial or SASH Kit 1 at start of tx.
If adding multi-dose vitamin
-10 cc syringe 1 1
-20 gauze 1 1/2 needle 1 1
IV Needleless system supplies PRN
~ more flush supplies if cyclic infusion
~ Lipids only Infusion
1 IV Tubing
1 IV Pump
Needleless system supplies
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APPENDIX "A" CONTINUED
IV Supplies included by Therapy
PROCALAMINE - CONTINUOUS INFUSION
Item Description # Units / per # days
----------------- -----------------------
IV Tubing 1 2-3 days
IV Pump 1 per tx. Duration
IV Dressing change kit 1 7
IV Securement device 1 7
0.9 NaCl multi-dose vial 30ml or SASH Kit 1 start of therapy, prn
IV Needleless system supplies PRN
PROCALAMINE / LIPIDS - CONTINUOUS INFUSION
Item Description # Units / per # days
----------------- -----------------------
IV Tubing with 1.2 micron filter 1 1
IV Pump 1 per tx. Duration
IV Dressing change kit 1 7
IV Securement device 1 7
0.9 NaCl multi-dose vial 30ml or SASH Kit 1 at start of tx, prn
IV Needleless system supplies PRN
ANTIBIOTIC/INTERMITTENT (PERIPHERAL)
Item Description # Units / per # days
----------------- -----------------------
IV Tubing* 1 1
IV Pump 1 per tx. Duration
IV Start Kit 1 2
IV Catheter 2 2
IV Securement Device 1 2
IV Needleless System Supplies PRN
IV Flush Supplies**
A. Pre-Filled Syringes 1 Pkg. 8-12 hours
B. Multi-Dose Vials
30ml 0.9NS 1 3
30ml Heparin Flush 1 3
* Use separate tubing for each antibiotic therapy
** Send additional specific flush supplies based on dose schedule of
antibiotics. Flush medications will be dispensed primarily in pre-filled
syringes, vials will be dispensed as extra backup supply or when
more appropriate.
▇▇
▇▇▇▇▇▇▇▇ "▇"
CLINICAL EDUCATION AND PROFESSIONAL SERVICES
-------------------------------------------------------------------------------
CLINICAL EDUCATION:
Course Listing Contact Hours Charge per Nurse Comments
-------------- ------------- ---------------- --------
Peripheral IV Course 19.4 $ 135.00
Total Parenteral Nutrition 2.6 $ 50.00
Care & Maintenance of Central Lines 5.0 $ 50.00
Pain Management 4.8 $ 50.00
Infusion Review Class 6.3 $ 100.00
Chemotherapy: Nursing Considerations 0 $ 50.00
Administration of Blood Products 0 $ 25.00
Midline Insertion 0 $ 250.00
Peripheral Phlebotomy 0 $ 50.00
PROFESSIONAL SERVICES:
Peripheral Insertion or Attempt $ 90.00
Midline/PICC Assessment $ 100.00
Midline Insertion or Attempt $ 150.00
PICC Insertion or Attempt $ 250.00
Remove PICC/Non-Tunneled Catheter $ 150.00
Access or De-Access Implanted Port $ 150.00
Declot Central Catheters $ 150.00
Repair Central Catheters $ 150.00
Blood transfusions will be billed at $ 80 hour for nursing services. If
NeighborCare must procure the blood and lab services, NeighborCare will ▇▇▇▇ at
its invoiced cost plus a 5% administrative fee.
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REQUIRED STANDARDS OF SERVICE FOR PHARMACY DISPENSING
Pharmacy Dispensing Model
- Within states permitting pharmacy prescription returns, a 28 or 30-day
dispensing system supply of medications will be provided.
- Within states NOT permitting pharmacy prescription returns, a 14-day
dispensing system supply of medications will be provided for all
Facility paid residents (i.e. Medicare Part A and Managed Care
patients). All other patients may be provided with a 28 or 30-day
supply of medications.
Returns/Restocking Fee
- There is a $5.00 restocking fee per prescription.
After Hours Service
- After hours non-emergency requests for the following will be provided
at a fee of $50 per request. Requests for special delivery, regardless
of whether they are subject to this $50 fee, will be met within four
(4) hours of request receipt:
- Routine medication refill (due to Facility error)
- Replace lost medication cart keys
- Non-emergency requests for equipment
- Floor stock/OTC orders
- Healthcare supply orders
- Emergency kit exchanges
- Providing prescription service to a Resident who has not
selected NEIGHBORCARE as his or her primary pharmacy supplier
Billing
- NEIGHBORCARE will ▇▇▇▇ the Facility as described in Section 5.1(c) and
the "Scope" section of this Exhibit "A" for Medicare A patients only.
At the Facility's discretion, private pay and/or selected third party
patients may be billed to the Facility at the same rate as a Medicare A
patient.
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Delivery
- The standard delivery model is a once a day delivery, seven days per
week. Facilities specified below will receive twice a day delivery due
to higher acuity patient needs. New orders will be delivered within 4
hours and may require special delivery outside of the standard delivery
run.
FACILITIES REQUIRING TWICE A DAY DELIVERY
DELIVERY FREQUENCY
FACILITY NAME (PER DAY)
------------- ------------------
WEST REGION
Driftwood Healthcare Center - Torrance 2
El Rancho Vista Healthcare Center 2
Flagship Healthcare Center 2
Florin Healthcare Center 2
Inglewood Healthcare Center 2
Palm Springs Healthcare Center 2
Santa ▇▇▇▇▇▇ Healthcare Center 2
Skyline Healthcare Center - Los Angeles 2
Tarzana Health and Rehabilitation Center 2
▇▇▇▇▇▇▇ Vista Healthcare Center 2
Autumn Hills Healthcare Center 2
Mission ▇▇▇▇▇▇▇▇▇▇ Healthcare Center 2
MID-AMERICA
Clinton-Aire Healthcare Center 2
Heritage Manor Nursing Center 2
Nightingale Healthcare Center 2
Southpointe Health Care Center 2
ATLANTIC COAST
Hallmark Healthcare Center ▇
▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ ▇
▇▇▇▇ ▇▇▇▇ Scranton Healthcare Center 2
Oakbrook Health and Rehabilitation Center 2
Prince ▇▇▇▇▇▇ Health Care Center 2
Springdale Healthcare Center 2
St. ▇▇▇▇▇▇ Health Care Center 2
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