Item C09C ounty of M onroe
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BOARD OF COUNTY COMMISSIONERS
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Mayor David Rice, District 4
The Florida Key
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Mayor Pro Tem Sylvia J. Murphy, District 5
Danny L. Kolhage, District 1
George Neugent, District 2
Heather Carruthers, District 3
County Commission Meeting
October 17, 2018
Agenda Item Number: C.9
Agenda Item Summary #4758
BULK ITEM: Yes DEPARTMENT: Emergency Services
TIME APPROXIMATE: STAFF CONTACT: Mary Napoli (305) 289 -6205
N/A
AGENDA ITEM WORDING: Approval for Monroe County Fire Rescue (MCFR) to register with
the Minnesota Multi -State Contracting Alliance for Pharmacy (MMCAP) to obtain free emergency
opioid antagonists without charge, and authorize the Fire Chief to execute all necessary documents
ITEM BACKGROUND: The Florida Department of Health (DOH) has offered emergency opioid
antagonists to Monroe County Fire Rescue at no charge through the "Helping Responders Obtain
Support" (HEROS) program. The DOH requires MCFR to register with MMCAP prior to releasing
the free emergency opioid antagonists.
PREVIOUS RELEVANT BOCC ACTION: N/A
CONTRACT /AGREEMENT CHANGES:
N/A
STAFF RECOMMENDATION: Approval.
DOCUMENTATION:
Stamped Signed Agreement with MMCAP
FINANCIAL IMPACT:
Effective Date: October 17, 2018
Expiration Date: B.A
Total Dollar Value of Contract: N/A
Total Cost to County: $0.00
Current Year Portion: $0.00
Budgeted: N/A
Source of Funds: N/A
CPI: N/A
Indirect Costs: None
Estimated Ongoing Costs Not Included in above dollar amounts: $0.00
Revenue Producing: No
Grant: N/A
County Match: N/A
Insurance Required: N/A
Additional Details:
If yes, amount: N/A
N/A
REVIEWED BY:
Mary Napoli
Completed
09/24/2018 3:55 PM
James Callahan
Completed
09/25/2018 10:42 AM
Pedro Mercado
Completed
09/25/2018 10:47 AM
Budget and Finance
Completed
09/25/2018 11:04 AM
Maria Slavik
Completed
09/25/2018 11:20 AM
Kathy Peters
Completed
09/25/2018 4:12 PM
Board of County Commissioners
Pending
10/17/2018 9:00 AM
Membership Application and Membership Agreement
Instructions for Completion
Thank you for your interest in membership with the Minnesota Multistate Contracting Alliance for Pharmacy
(MMCAP). Processing a new membership application generally takes less than a week after MMCAP
receives it. You will receive a welcome letter and copy of the fully executed Membership Agreement
after the membership has been activated.
Eligibility
Membership in MMCAP is limited to facilities that.
1. Have legal authority to contract with the State of Minnesota, and
2. The State of Minnesota has legal authority to contract with the entity. Minnesota's authority is limited
by Minnesota Statutes Section 471.59, subdivision 10 to:
• Other states
• Agencies of other states
• Counties
• Cities
• School Districts
• Federally recognized Indian tribes
• Entities recognized by the member state's statutes as authorized to use that state's
commodity or service contracts (Minnesota Statutes Section 16C.03, subdivision 10 —
found at: In tt,12 s: 'gz�vw.reviefl G ov staai i'id= 16C.03).,
Application Check List:
❑ Application fully completed with each question answered
If this application includes multiple ship -to locations contact MMCAP Membership at
651.201.2420.
❑ Application signed by facility representative
❑ Member Facility Agreement fully executed by proper authority of the facility applying
❑ Application and Member Facility Agreement forwarded to the applicable MMCAP State Contact for
final processing
If you have any questions, please contact MMCAP at 651.201.2420.
Rev. 12/2016
Page 1 of 8
(;,, MMCAP
Minnesota Multistate Contracting Alliance for Pharmacy
Facility Membership Application
Forward the completed application and executed Member Facility Agreement to your State Contact for final
processing. (A list of State Contacts may be found at www.mmcap.org, click on "What is MMCAP," then on "State
Contacts. ") The State Contact will then forward the authorized form to the MMCAP office for processing.
Type or Print C1eaft
1. Indicate the specific legal authority�under which this facility may purchase goods and services from MMCAP:
(i.e., statutory auth amity to be able to contract with the State of"Minnesota or governing board resolution). Leave
blank if you need assistance with this question from the MMCAP State Contact or MMCAP.
2. Facility's Full Legal Name (no abbreviations):
V S#ff� 00W
3. Complete `Bill To" Street Address: , C
City: a a&m State: Zip:
4. Complete "Ship To" Street Address, if different:
City: State: Zip:
* If this application incl udes multiple ship -to locations contact MMCAP Membership at 651.201.2420
5. Facility Website: WWA / • 01a4NOO-COU f l • 40VI? / ,C/t `k IIQ
6. What type of entity is the facility? (Check one)
❑ State Government
County /Parish Government
❑ Municipal Government
7. What is the primary purpose of your facility? (Check one)
❑ Central Purchasing /Business Office
❑ Correctional Facility
❑ Convalescence /Nursing Facility
❑ Mental Health
❑ Public Health
❑ Non - government Private — for profit
❑ Non- government Private — non - profit
❑ Federal Government
Public Safety /First Responders
❑ School /College /University
❑ Veterinary
❑ Other
S. Health Industry Number (HIN), if known: o, in Qb .
MMCAP can assist in obtaining tins number when the application is processed. Indicate need for assistaid on line above.
9. DEA Number, if applicable (required for controlled substances): 514169
Rev. 12/2016 Page 2 of 8
10. Facility's State Pharmacy License Number, if applicable:
it
11. Indicate which MMCAP programs the facility intends to use? (Check all that apply)
❑ armacy Program
P
Pharmaceutical Wholesaler Services
(AmerisourceBergen, Cardinal Health, or
Morris & Dickson)
❑ Products
❑ Prescription Drugs (other than vaccines)
❑ Vaccines (other than influenza)
❑ Over -the- counter
❑ Nutritionals
• Diabetic Supplies (meters/strips/syringes)
• Containers and Vials
❑ Contract Price Auditing
❑ Returned Goods Processing
❑ Pharmaceutical Repackaging
Influenza Vaccine Program
❑ Prescription Filling /Pharmacy Service Program
❑ Student Health Oral Contraceptives Program
er Emergency Preparedness/ Stockpiling Program
J Healthcare Products and Services Program
❑ Medical Supplies & Distribution Services
• Dental Supplies & Distribution Services
• Drug Testing Kits and Services
❑ Laboratory Supplies
❑ Condoms
12. Is the facility 340B (PHS)* Eligible?
*The Federal 340B Drug Pricing Program provides significant pharmaceutical discounts to facilities receiving certain types of federal
government funding.
❑ I' s
No
❑ Unsure
13. 'vX the past year, has this facility been affiliated with a pharmaceutical group purchasing organization (GPO) other than
M MCAP? (Please check one.)
® No
❑ Yes, but the facility is switching to MMCAP. Attach a signed letter on the facility's letterhead stating that it wishes to
discontinue your association with its current pharmaceutical GPO and use MMCAP instead.
❑ Yes and the facility will remain with its current GPO.
Current pharmaceutical GPO Name:
Products the facility currently purchases:
Rev. 12/2016
Page 3 of 8
14. Which best describes this facility? (Check all that apply)
Acute Care
❑ Adult Daycare
❑ Ambulatory Care Pharmacy
❑ Assisted Living
❑ Clinic (if checked, then check all that apply)
❑ city
❑ dental
❑ dialysis
❑ oncology infusion clinic or practice
❑ outpatient
❑ radiolo,g� services
❑ state
❑ surgical
❑ WIC (wonaen, infant, children)
❑ Central Purchasing /Business Office
❑ Community /Public Health Nursing
❑ Corrections
❑ city_Tail
❑ couno jail
❑ state Prison
❑ Dentist
❑ Detoxification
❑ Education
❑ school district
❑ elementag
❑ secondag
❑ post- secondag
Emergency First Responders
Emergency Medicine & Ambulance
Emergency Preparedness
Health Service
❑ Home Health
❑ home bealtb provider, non
❑ home infusion
❑ horwe medical equipment
❑ Hospice
❑ Hospital (if checked, then check all that apply)
❑ acute care
❑ citylcotlntg /state
❑ ,ysis
❑ long- terrre care
❑ oncology infusion clinic orpractice
• outpatient
• radiology services
❑ sumical
❑ Juvenile Detention
❑ Laboratory services
• Long Term Care
• Mail Order Pharmacy
❑ Mental Health (if checked, then check all that apply)
❑ ICFMR (intermediate care facility for)) retarded)
❑ inpatient
❑ outpatient
❑ developmental disabilities
❑ No Care Provided
❑ Nursing Facility
❑ convalescences
❑ nursing home
❑ inpatient
❑ outpatient
❑ Nutrition Services
❑ Other (State and Local Gov't) healthcare related:
❑ Pa ent Population Served
." pediatrics
N7 adult
geriatrics
Public Health
Public Safety
❑ Rehabilitation (if checked, then check all that apply)
❑ inpatient
❑ outpatient
❑ skilled nursing facilities
• Research /Training
• Senior Services
• Skilled Nursing Facilities
• Specialty Pharmacy/ Special Care
❑ Student Health
❑ Surgery Center
❑ University (if checked, then check all that apply)
❑ teaching hospital
• training or research (clinic research centers)
• college student health services
❑ pharmacy school
• Urgent Care Center
• Veterans Home — State
• Veterinary
• veterinary medicine
• veterinary medicine — ).tniversity dept
❑ veterinary zoological medicine
Rev. 12/2016 Page 4 of 8
Facility Contacts: Not all facilities will have three contacts. Listing at least one main contact person is
required.
15. Designated Facility MMCAP contact person: L. i
Title: L 'CU &S1 S Phone: -Q `° ® ®5d Fax: 30,7-2 9® �
Email Address:
W
16. Alternate Facility MMCAP contact person: SQ
Title: I Phone: Fax:
Email Address: 11 UOI
17. Facility's Purchasing MMCAP contact person: NAPOL
Title: - AMCOVE &WSMAE Phone: - 0 6009 Fax: 33
Email Address:
Applicant Facility:
The information above is true anct correct.
Signed:
Facility Representative
MMCAP State Contact Review:
Date:
Forward signed application and agreement on to the applicable MMCAP State Contact for final processing.
A list of MMCAP State Contacts may be found at v IE- 11snrr ca _ .or click on "What is MMCAP," then on
"State Contacts." Facilities located in Connecticut, Illinois, Massachusetts, Ohio, and Pennsylvania mail
directly to rnn.multistate%
I have reviewed and approve the facility's eligibility for membership in MMCAP.
Signed:
MMCAP State Contact
Date
Rev. 12/2016
Page 5 of 8
_......._..._ .. - — —- C.9.a;
The Member Facility desires to access 1MMCAP's programs to purchase products and services for the
Member Facility.
1. Term of Agreement and Cancellation
This Agreement, which is required by 42 C.F.R. § 1001.9520 and Minnesota law, will be effective upon the
date it is fully executed by all parties; and will remain in effect until cancelled by MMCAP or the Member
Facility. This Agreement may be cancelled by either party upon 30 days' written notice to the other party, or
immediately upon material breach by one of the parties.
2. Member Facility
The Member Facility:
A. Certifies it has authority to enter into this Agreement with the State of Minnesota and, where
applicable, authorizes MMCAP to negotiate contracts on its behalf. For non - government entities,
also certifies it has statutory authority under which it may purchase goods and services from its
state's contracts.
B. Must comply with all applicable laws, rules, and regulations governing government purchasing of
pharmaceuticals, and related products and services when utilizing NiNICAP contracts and
programs.
C. Should endeavor, where practical, to purchase its goods and services from MMCAP contracts.
D. Acknowledges it will be bound by applicable antitrust laws (Robinson - Patman (15 1 J.S.C. 13 (a))
and purchase products for its "own use" as defined by Abbott. Labs v. Portland Retail Druggists (425
U.S. 1(1976)) and Jefferson County Pharmaceutical Association, Inc. v. Abbott Labs (460 U.S. 150 (1983)).
E. Will not resell (as may be prohibited by law) or divert products obtained under the MMCAP
contracts. If there are any questions about the propriety of the use of products purchased from
the MMCAP contracts, the Member Facility will obtain an opinion from its legal counsel and
notify MMCAP of the decision.
F. When applicable, acknowledges that the prices made available under MMCAP's contracts may
represent a discount to price that must be properly and accurately accounted for and reported in
accordance with all federal and state laws, including the anti - kickback law (42 C.F.R. 5 1320a-
7b(b)(3)(A)) and regulations thereunder (42 C.F.R. 51001.952(h)).
Rev. 12/2016 Page 6 of 8
G. Must comply with the terms and conditions of the applicable MMCAP vendor contract data.
sheets; found on the MMCAP website at maL/✓ v .mmca o
H. Understands that MMCAP is not liable for any denied pricing, chargeback, refusal of vendors to
honor contract pricing, or failure of vendors to deliver the products or services. THE
MEMBER FACILITY ACKNOWLEDGES THAT NTAICAP IS NOT THE
MANUFACTURER OR DISTRIBUTOR OF ANY PRODUCT AND SERVICE AND
MAKES NO REPRESENTATION AS TO WARRANTY OF QUALITY,
MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, CONDITION, OR
OTHER ATTRIBUTE OF THE PRODUCTS SUPPLIED BY VENDORS UNDER MMCAP
CONTRACTS.
I. Must update MMCAP regarding changes to the Member Facility information and contact person
information.
J. Must promptly pay MMCAP - contracted vendors for all products or services purchased. MMCAP
does not assume any responsibility for dle accountability of funds expended by the member
Facility.
K. May be inactivated from MMCAP membership if there is no participation for 18 consecutive
months.
3. MMCAP
MMCAP will:
A. Select products or services for cooperative contracting under the programs offered.
B. Comply with Minnesota laws, including procurement and data practices, that require fair and open
competition.
C. Make available copies of contract documents.
D. Maintain vendor performance records.
E. Assist in resolving administrative, contract, or supplier problems that cannot be resolved by the
Member Facility,
F. Provide information to the Member Facility regarding products and services available through the
NLMCAP program.
G. Distribute to Member Facilities anv unused administrative fees collected from contracted vendors
(Article 4 below); and annually disclose in writing to Member Facilities, and to the Secretary of the
United States Department of Hcalth and Human Services upon request, the amounts received by
MMCAP from vendors that were directly attributable to the Member Facility's purchases.
4. Administrative Fee Collected from MMCAP's Vendors
The MMCAP Managing Director may, pursuant to contract terms and conditions, require the contracted
vendors (not Member Facilities) to pay an administrative fee to MMCAP. The fee of not more than three
percent will be based on a percentage of sales made through the individual contracted vendor. Fees will be
collected by the MMCAP office and used to pay for the administrati ve costs incurred in the operation of
MMCAP as approved by the MMCAP Managing Director. Any remaining balance of funds will be returned
to active members by means of either a credit to their wholesaler or distributor account, or other mechanism
agreed to by the parties, in an amount proportional to the Member Facility's on- contract purchases.
5. Assignment, Amendments, Waiver, and Contract Complete
5.1 Assignment. Neither party may assign or transfer any rights or obligations under this Agreement without
the prior consent of the other party and a fully executed assignment agreement.
5.2 Amendments. Any amendment to this Agreement must be in writing and will not be effective until it has
been executed and approved by the same parties who executed and approved the original agreement.
5.3 Waiver. If either party fails to enforce any provision of this Agreement, that failure does not waive the
provision or its right to enforce it.
Rev. 12/2016
Page 7 of 8
6. Liability
Each party will be responsible for their own acts and behavior and the results thereof. Nothing
in this membership agreement will be construed as expanding the limits of liability of the Member Facility
beyond the limits of the law of its state. MMCAP's liability is governed by the Minnesota Tort Claims Act,
Minnesota Statutes Section 3.736, and other applicable laws.
7. State Audits
As mandated by Minnesota Statutes Section 16C.05, subdivision 5, "the books, records, documents and
accounting procedures and practices of the [Member Facility] relevant to this Agreement shall be made available
and subject to examination by the State of Minnesota, including the contracting agency Division, Legislative
Auditor, and State Auditor" for a minimum period of six years after the termination of this Agreement.
IN WITNESS WHEREOF, the undersigned parries represent they have the authority to bind their respective party
and have signed intending to be bound thereby.
Member Facility:
(Person with legal authority to bind the facility)
State of Minnesota, through its Commissioner of
Administration on behalf of MCAP:
0
Title:
Date:
By:
Title:
Date:
Commissioner of Administration, as delegated to the
Materials Management Division:
By:
Rev, 12/2016 Page 8 of