Pima County Notice of Request For Proposals (RFP)

PIMA COUNTY NOTICE OF REQUEST FOR PROPOSALS (RFP)
Solicitation Number: 1001249 Title: Pharmacy Benefit Manager & Pharmacy Services
(Commodity Codes 0269, 0271, 0948 and 0952)
DUE IN AND OPENS: FEBRUARY 16, 2010 AT OR BEFORE 10:00 A.M. LOCAL ARIZONA TIME
Submit Proposal to: Pre-Proposal Conference: February 1, 2010 AT 1:00 P.M. Local Arizona Time
Pima County Procurement Department Pima County Procurement Department
130 West Congress, 3rd Floor, Receptionist 130 West Congress, 3rd Floor
Tucson, Arizona 85701 Tucson, Arizona 85701
SOLICITATION: Pima County is soliciting proposals from Offerors qualified, responsible and willing to provide the
following Goods and/or Services in compliance with all solicitation specifications and requirements contained or
referenced herein.
GENERAL DESCRIPTION: To provide pharmacy benefit manager and pharmacy services to Pima Health System; per
specifications called for herein for a one-year period with four (4) one-year renewal options.
You may download a full copy of this solicitation at www.pima.gov/procure/ifbrfp.htm by selecting the solicitation number.
Offerors are required to check this website for addenda prior to the Due In and Opens Date and Time to assure that the
proposal incorporates all addenda. Prospective Offerors may also pick up a copy, Monday through Friday excluding legal
holidays, 8 am to 5 pm MST, at the address listed above.
A Pre-Proposal Conference will be held for the purpose of clarifying requirements and answering prospective
offeror questions. It is the responsibility of Prospective Offerors to familiarize themselves with all requirements
of the solicitation and to identify any issues at the conference. Attendance is optional and encouraged.
Proposals shall be submitted as defined in the Instructions to Offerors, in accordance with the Standard Terms and
Conditions, and all solicitation documents either referenced or included herein. Failure to do so may be cause for rejection
as non-responsive. Offerors must complete and return those documents identified in the Instruction to Offerors
Submission of Proposals instruction. Timely submittals will be opened and recorded promptly after the Due In Date and
Time.
Proposals may not be withdrawn for 90days after opening except as allowed by Pima County Procurement Code.
The following licenses are required: Pharmacist license issued by the Arizona State Board of Pharmacy.
Bonds are not required.
OFFERORS ARE REQUIRED TO READ THE ENTIRE SOLICITATION, INCLUDING ALL REFERENCED DOCUMENTS,
ASSURE THAT THEY CAN AND ARE WILLING TO COMPLY, AND TO INCORPORATE ALL ASSOCIATED COSTS IN
THEIR PROPOSAL.
Questions and Deviation requests shall be submitted in writing (referencing Solicitation Number and Title) to
Procurement Department, Attention: Nina Schatz No Later Than 1:00 P.M. Tucson, Arizona Time on February 1, 2010
Deadline. The County may not address questions and deviation requests received after this deadline date and time.
Responses to questions and deviation requests may be answered via email or addenda to the solicitation.
Fax: (520) 791-6511 email: [email protected]
USPO Mail to the following address:

Pima County Procurement Department, 130 W. Congress, 3rd Floor, Mailstop # DT-AB3-126; Tucson, AZ 85701
VERBAL REQUESTS FOR CLARIFICATIONS OR INTERPRETATIONS WILL NOT BE ACCEPTED.
Nina Schatz
Commodity/Contracts Officer Publish: The Territorial: January 22, 25, 26 and 27, 2010
Solicitation # 1001249
INSTRUCTIONS TO OFFERORS
1. PREPARATION OF RESPONSES
All proposals shall be made using the forms provided in this package. All prices and notations must be printed in ink or
typewritten. No erasures are permitted. Errors may be crossed out and corrections printed in ink or typewritten adjacent
to error and shall be initialed in ink by person signing the proposal. Typewritten responses are preferred.
All proposals shall as appropriate indicate the registered trade name, stock number, and packaging of the items included
in the proposal.
Surety required by this solicitation may be in the form of a bond, cashier's check or certificate of deposit made payable to
Pima County. Personal or company checks are not acceptable.
2. PRICING and OFFER DOCUMENTS

Throughout this solicitation document, the meaning of proposal and offer are intended to be synonymous.
Offerors shall complete and submit their offers utilizing the forms provided by this solicitation. Requested information and
data shall be provided in the precise manner requested. Product descriptions shall provide sufficient information to
precisely document the product being offered. Failure to comply may cause the proposal to be improperly evaluated or
deemed non-responsive.
The proposal/offer certification document must be completed and signed by an authorized representative certifying that
the firm can and is willing to meet all requirements of the solicitation. Failure to do so may be cause to reject the proposal
as non-responsive.
All unit prices shall remain firm for the initial term of the executed agreement, with the exception that should offeror during
the term of the agreement offer to another buyer pricing for like or similar quantity, products or services at price more
favorable than those given to the County, that offeror shall offer same pricing to County effective on the date offered to
other buyer. Unit prices given by offeror shall include all costs required to implement and actively conduct and document
cost control and reduction activities. Unit Prices shall include all costs and, unless otherwise specified, shall be F.O.B.
Destination & Freight Prepaid Not Billed (“F.O.B. Destinations”). Unit prices shall prevail in the event of an extension error.
Price each item separately. Delivery time if stated as a number of days, shall mean "calendar" days. Pima County
reserves the right to question and correct obvious errors.
3. GENERAL SPECIFICATIONS & DEVIATIONS

The specifications included in this solicitation are intended to identify the kind and quality of goods and/or services to be
provided without being unnecessarily restrictive, and as required to provide the information needed for the development of
consistent and comprehensive proposals.
Equipment brand names, models and numbers, when given are intended to identify a level of quality, equivalent
performance and dimensional specifications, and are for reference only, unless otherwise specified in the solicitation.
Failure to perform appropriate research, discovery, examine any drawings, specifications, and instructions will be at the
offeror's sole risk.
Items included in the proposal shall meet the specifications and requirements set forth by the solicitation.
Deviation requests shall specifically document and clearly illustrate the deviation to the particular specification or the
requirement set forth by this solicitation and fully explain the requested deviation’s impact on the end performance of the
item. Deviation requests shall be submitted to the County as soon as possible and prior to the deadline date and time
specified on the cover sheet of this document. Acceptance or rejection of said deviation request shall be at the sole
discretion of the County and in accordance with Pima County Procurement Code.
Offerors are advised that conditional offers that do not conform to or that request exceptions to the published solicitation
and addendums may be considered non-responsive and not evaluated.
All equipment shall be models of current production, latest design and technology, new and unused unless otherwise
specified Manufacturer and offeror documentation, including and not limited to the following shall be provided by the
successful offeror not later than 14 days after request by the County and at no additional cost; warranty; caution-
informational warnings; recommended maintenance schedule and process; recommended spare parts list; operating,
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INSTRUCTIONS TO OFFERORS (continued)
technical and maintenance manuals including drawings, if appropriate; product brochures; and material safety data sheets
(MSDS).
4. OFFERORS MINIMUM QUALIFICATIONS

In order for proposals to be evaluated and considered for award, proposals must be deemed Responsive and
Responsible. To be deemed “Responsive”, the submitted offer documents shall conform in all material respects to the
requirements stated by the solicitation. To be deemed “Responsible”, offerors shall document and substantiate their
capability to fully perform all requirements defined by the solicitation. Factors considered include and may not be limited to
experience, integrity, perseverance, reliability, capacity, facilities, equipment, credit and other factors required to provide
the performance defined by the solicitation.
Offeror shall certify that they possess the minimum qualifications contained in Exhibit A: Minimum Qualifications
Verification Form. Offeror shall provide the requested documents that substantiate their satisfaction of the Minimum
Qualifications. Failure to provide the information required by these Minimum Qualifications and required to substantiate
responsibility may be cause for the offeror’s proposal to be rejected as Non-Responsive and/or Non-Responsible.
5. EVALUATION AND AWARD CRITERIA

It is County’s intent to award one contract with award amount of 5,000,000.00 for the initial one-year agreement with
option to renew for up to four (4) additional one-year periods.
Pima County shall evaluate proposals deemed Responsive and Responsible. Proposals shall be evaluated according to
the evaluation criteria set forth herein. Evaluation of cost shall be made without regard to applicable taxes.
CRITERIA MAXIMUM POINTS

A. Cost 50 points
B. Company Capability 30 points
C. Financial Stability & Strength 10 points
D. References 10 points
Total 100 points
The evaluation criteria will be used by the evaluation panel when scoring the offeror’s answers to the questions contained
in Exhibit B: Proposal Pricing Sheet, Exhibit C: Company Capability Questionnaire Sheet, Exhibit D: Financial
Questionnaire Sheet and Exhibit E: Reference Sheet. Offeror should respond in the form of a thorough narrative to
each specification as guided by the Questionnaire. The narratives along with required supporting materials should be
evaluated and awarded points accordingly. Forms provided and requested for inclusion in this proposal shall not be
modified.
Evaluation Criteria
The evaluation committee will assign points to each proposal submitted on the basis of the following evaluation criteria,
unless otherwise indicated:
A. Cost (0 to 50 points)
Offerors shall propose firm, fixed and fully-loaded cost per service category. The firm, fixed, fully-loaded cost shall
include all direct cost, indirect cost, overhead and profit margin, as well as subcontractor’s total costs if appropriate.
The drug cost categories are as follows:

1. Paid Claims Transaction Fee (0 to 10 points)
2. Average Wholesale Price (AWP) minus percent discount for Brand Name Drugs (0 to 20 points)
3. Average Wholesale Price (AWP) minus percent discount for Generic Drugs (0 to 10 points)
4. Maximum Allowable Charges (MAC) Pricing (0 to 10 Points)
COST POINTS CALCULATION

Points for the cost will be calculated by the Procurement Department based on the following formula:
1. Paid Claims Transaction Fee

Lowest “Total Price Proposed” (TPP) will receive the maximum quantity of points. Other proposals will be
allocated points using the following formula: (Lowest TTP / Other TPP) x 10 Points = Score
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2. Brand Name Drugs

Highest “Total Savings Proposed” (TSP) will receive the maximum quantity of points. Other proposals will
be allocated points using the following formula: (Other TSP / Highest TSP) x 20 = Score
3. Generic Drugs
Highest “Total Savings Proposed” (TSP) will receive the maximum quantity of points. Other proposals will
be allocated points using the following formula: (Other TSP / Highest TSP) x 10 = Score
4. MAC Pricing
Lowest “Total Price Proposed” (TPP) will receive the maximum quantity of points. Other proposals will be
allocated points using the following formula: (Lowest TTP / Other TPP) x 10 Points = Score
B. Company Capability (0 to 30 points)

Offerors should include in their proposals documentation describing the extent of their capability including
documentation and methodology to support its ability to comply a list of tasks provided in the Exhibit C: Company
Capability Questionnaire Sheet. Offerors should provide resumes of all proposed key personnel who will be
performing services under the contract. Offerors shall include in their proposal copies of appropriate professional
certifications for key personnel.
Offerors should include in their proposals sample of work performed for their clients.
Points for the company capability will be based on documented successful services on similar size and requirements
of Pima Health System.
C. Finance Stability and Strength (0 to 10 points)

Offerors should provide in a separate envelope the firm’s most recent audited Financial Statements that attest to a
financial capacity. If an audited financial statement is not available, offerors may submit a compiled financial
statement reviewed and signed by an outside certified public accountant. However a lesser evaluation point will be
assigned due to the reduced confidence in the information provided. Offerors shall be prepared to substantiate all
information provided if requested by the COUNTY. Financial statements not meeting this requirement shall be
assigned zero point for this criterion. Financial statements will be reviewed by an accountant who will be looking for
indicators of a fiscally healthy company and risk factors that might predict future inability to perform services resulting
from this solicitation. The evaluator will summarize their findings and rate each on a risk scale of low, medium, or high.
A rating of low risk indicates that a firm is financially able to perform to a contract resulting from this solicitation with
little risk to the COUNTY that their financial status will negatively impact the program.
In Addition, Offeror shall complete Exhibit D: Financial Questionnaire.
D. References (0 to 10 points)
Offeror shall have three (3) professional references documenting the offeror’s ability and expertise in providing the
similar services in this solicitation. Offeror shall their references as provided in Exhibit E: Reference Form.
Points for the references will be based on the offeror’s work for its clients receiving similar services to this solicitation.
Oral Presentation
The Commodity/Contracts Officer may notify finalists of the date, time and location of the oral presentations. The
presentation may include the demonstration of offeror’s capability, reporting methodology and communication ability
included in the proposal. Points for the oral presentation will be based on presenter’s knowledge, effectiveness of
communication, experience with similar contracts and the quality of the responses to questions during the presentation.
County reserves the right to request additional information and/or clarification. Any clarification of a proposal shall be in
writing. Recommendation for award will be to the responsible and responsive offeror whose proposal is determined to be
the most advantageous to the County taking into consideration the evaluation criteria set forth in this solicitation.
If an award is made, the County will enter into an agreement with one Offeror that submitted the highest scoring
responsive and responsible offer. The County may conduct discussions with the Offeror to clarify the Offer and Agreement
details provided that they do not substantially change the intent of the solicitation. Unless otherwise specified, relative
ranking of proposals will be made considering the average of total points given to each proposal by evaluators.
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6. SUBMISSION OF OFFERS
Offerors are to complete, execute and submit one original and four (4) copies of the required documents except the
Financial Statements. One Original and one (1) copy of the Financial Statement are required. The submittal shall
include all information requested by the solicitation in the follow order, and utilize without modification the forms provided
by the solicitation that includes and may not be limited to the following:
6.1 Exhibit G: Certification Form, fully completed, signed and executed as requested.
6.2 Exhibit A: Minimum Qualifications Verification Form, fully completed as requested, including the required
documentation.
6.3 Exhibit B: Proposal Pricing Sheet, fully completed as requested, including MAC pricing in an Excel format on a
CD-ROM (one original is required and one copy are required).
6.4 Exhibit C: Company Capability Questionnaire, fully completed as requested, including all requested
documentation and your MAC list and pricing in an Excel format on a CD-ROM (one original and one copy are
required).
6.5 Exhibit D: Financial Questionnaire, fully completed as requested, including all requested documentation.
6.6 Exhibit E: Reference Form, fully completed as requested.
6.7 Exhibit F: Sustainability Questionnaire, fully completed as requested.
The proposal shall be bound and indexed in the order as indicated above with the exception of Exhibit D Reference
documents which shall be submitted by the selected Reference Firms. Please do not use 3-ring hard cover binders.
Proposals must be received and time stamped at the specified location at or before the Due Date/Time as defined by the
Request For Proposals. Unless specifically requested (References) facsimiles will not be accepted. The ‘time-stamp”
provided by the County shall be the official time used to determine the timeliness of the submittal. Proposals and
modifications received after the Due Date/Time will not be accepted or will be returned unopened. Timely submittals will
be opened and recorded promptly after the Due Date/Time.
Proposals must be signed by an authorized agent of the respondent and submitted in a sealed envelope marked or
labeled with the respondent firm name, solicitation number, title, solicitation due date and time, to the location and not
later than the Due Date/Time specified by the Request For Proposals.
Failure to comply with the solicitation requirements may be cause for the offeror’s proposal to be rejected as non-
responsive and not evaluated.
7. BEST AND FINAL OFFER

County reserves the right to request additional information and/or clarification with responsible offerors who submit
proposals determined to be reasonably susceptible of being selected for award for the purpose of clarification to assure
full understanding of, and conformance to, the solicitation requirements.
In the event that discussions are held and clarifications are requested, a written request for best and final offers shall be
issued. The request shall set forth the date, time, and place for the submission of best and final offers. If offerors fail to
respond to the request for best and final offer or fail to submit a notice of withdrawal, their immediate previous offer will be
construed as their best and final offer.
8. COMPLIANCE WITH AGREEMENT

County will execute an agreement with the successful offeror by issue of a blanket contract, purchase order or contract.
The offeror agrees to establish, monitor, and manage an effective administration process that assures compliance with all
requirements of the agreement. In particular, the offeror agrees that they shall not provide goods or services in excess of
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the executed agreement items, item quantity, item amount, or agreement amount without prior written authorization by
revision or change order properly executed by the County. Any items provided in excess of the quantity stated in the
agreement shall be at the Offeror’s own risk. Offerors shall decline verbal requests to deliver items in excess of the
agreement and shall report all such requests in writing to the Pima County Procurement Department within 1 workday of
the request. The report shall include the name of the requesting individual and the nature of the request.
9. INQUIRIES
Offerors may submit questions until the close of business as specified by the Pre-Proposal Conference Date. If a
prospective offeror believes a requirement of the solicitation documents to be needlessly restrictive, unfair, or unclear, the
offeror shall notify the Pima County Procurement Department in writing identifying the issue with suggested solution prior
to the closing time set for receipt of the solicitation proposal. Issues identified less than 8 days prior to the solicitation
opening date may not be answered.
Any question related to this solicitation shall be directed to the Commodity/Contracts Officer of this RFP. The offeror shall
not contact or ask questions of the department for whom the requirement is being procured. The questions must be
submitted in writing. Any correspondence related to a solicitation should refer to the appropriate solicitation number, page
and paragraph number. The County may issue a formal written addendum containing clarifications or modifications of the
RFP requirements, if deemed advantageous or necessary. Only questions or issues answered by formal written
addendum will be binding. Addendum will be posted on the Pima County Procurement Solicitation Website:
http://www.pima.gov/procure/ifbrfp.htm.
Results of this procurement will not be given in response to telephone inquiries. Interested parties are invited to attend the
public opening at the time and date stated in this solicitation. A tabulation of submittals will be on file at the Procurement
Department.
No oral interpretations or clarifications will be made to any offeror as to the meaning of any of the solicitation documents.
10. VENDOR RECORD MAINTENANCE

By submitting a response to this solicitation, the submittor agrees to establish and maintain a complete Pima County
Vendor record, including the provision of a properly completed and executed “Request for Taxpayer Identification
Number and Certification” document(Form W-9), within ten calendar days of the solicitation due date. The Vendor also
agrees to update the information within ten calendar days of any change in that information and prior to the submission of
any invoice or request for payment. The preferred method for creating or updating this record is via the Internet utilizing
the Pima County Vendor Registration and Messaging Portal (VRAMP). The portal requires that the Vendor establish and
maintain email functionality. In addition to providing the means for a Vendor to create and maintain their Vendor record,
VRAMP also provides for email notice to the vendor regarding solicitations published by Pima County for commodities of
interest as defined by the Vendor record. Internet links for Vendor Registration, VRAMP and commodity codes used to
define products and services for which the Vendor is capable of providing, are located at the Procurement Internet page:
www.pima.gov/procure .
END OF INSTRUCTIONS TO OFFERORS
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PIMA COUNTY STANDARD TERMS AND CONDITIONS (07/30/09)
1. OPENING:
Responses will be publicly opened and respondent’s name, and if a Bid the amount, will be read on the date and at the
location defined in the Invitation for Bid (IFB) or Request For Proposals (RFP). Proposals shall be opened so as to avoid
disclosure of the contents of any proposal to competing Offerors during the process of negotiation. All interested parties
are invited to attend.
2. EVALUATION:
Responses shall be evaluated to determine which response is most advantageous to the COUNTY considering evaluation
criteria, conformity to the specifications and other factors.
If an award is made, the Pima County (COUNTY) will enter into an agreement with the one or multiple respondent(s) that
submitted the lowest bid(s) and determined responsible for supplying the required goods or services. Unless otherwise
specified on the Bid/Offer document determination of the low/lowest bids will be made considering the total bid amount.
The COUNTY reserves the following rights: 1) to waive informalities in the bid or bid procedure; 2) to reject the response
of any persons or corporations that have previously defaulted on any contract with COUNTY or who have engaged in
conduct that constitutes a cause for debarment or suspension as set forth in COUNTY Code section 11.32; 3) to reject
any and all responses; 4) to re-advertise for bids previously rejected; 5) to otherwise provide for the purchase of such
equipment, supplies materials and services as may be required herein; 6) to award on the basis of price and other factors,
including but not limited to such factors as delivery time, quality, uniformity of product, suitability for the intended task, and
bidder’s ability to supply; 7) to increase or decrease the quantity herein specified. Pricing evaluations will be based on
pre-tax pricing offered by vendor.
3. AWARD NOTICE:
A Notice of Recommendation for Award for IFB or RFP will be posted on the Procurement website and available for
review by interested parties. A tabulation of responses will be maintained at the Procurement Department.
4. AWARD:
Awards shall be made by either the Procurement Director or the Board of Supervisors in accordance with the Pima
County Procurement Code. COUNTY reserves the right to reject any or all offers, bids or proposals or to waive
irregularities and informalities if it is deemed in the best interest of the COUNTY. Unless expressly agreed otherwise,
resulting agreements are not exclusive, are for the sole convenience of COUNTY, and COUNTY reserves the right to
obtain like goods or services from other sources.
5. WAIVER:
Each respondent, by submission of an offer, bid or proposal proclaims and agrees and does waive any and all claims for
damages against COUNTY or its officers or employees when any of the rights reserved by COUNTY may be exercised.
6. ACKNOWLEDGEMENT AND ACCEPTANCE:

If Contractor’s terms of sale are inconsistent with the terms of the resultant agreement, the terms herein shall govern,
unless Contractor’s terms are accepted in writing by COUNTY. No oral agreement or understanding shall in any way
modify this order or the terms and conditions herein. Contractor’s acceptance, delivery or performance called for herein
shall constitute unqualified acceptance of the terms and conditions of the resultant agreement.
7. INTERPRETATION and APPLICABLE LAW:

The contract shall be interpreted, construed and given effect in all respects according to the laws of the State of Arizona. If
any of Contractors’ terms or conditions is not in agreement with County’s terms and conditions as set forth herein,
COUNTY's shall govern. This Agreement incorporates the complete agreement of the parties with respect to the subject
matter of this Agreement. No oral agreement or other understanding shall in any way modify these terms and conditions.
8. WARRANTY:
Contractor warrants goods or services to be satisfactory and free from defects.
9. QUANTITY:
The quantity of goods ordered shall not be exceeded or reduced without written permission in the form of a properly
executed blanket contract, purchase order or contract revision or amendment as required by COUNTY Procurement Code
except in conformity with acknowledged industry tolerances. All quantities are estimates and no guarantee regarding
actual usage is provided.
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10. PACKING:
No extra charges shall be made for packaging or packing material. Contractor shall be responsible for safe packaging
conforming to carrier’s requirements. All packages shall bear the content(s) quantity, product identification, purchase
order number, and destination address plainly marked in indelible ink on the exterior of each package.
11. DELIVERY:
On-time delivery of goods and services is an essential part of the consideration to be received by COUNTY.
A guaranteed delivery date, or interval period from order release date to delivery, must be given if requested by the Price
offer document. Upon receipt of notification of delivery delay, COUNTY at its sole option and at no cost to the COUNTY
may cancel the order or extend delivery times. Such extension of delivery times will not be valid unless extended in writing
by an authorized representative of the COUNTY.
To mitigate or prevent damages caused by delayed delivery, COUNTY may require Contractor to deliver additional
quantity utilizing express modes of transport, and or overtime, all costs to be Contractor responsibility. COUNTY reserves
the right to cancel any delinquent order, procure from alternate source, and/or refuse receipt of or return delayed
deliveries, at no cost to COUNTY. COUNTY reserves the right to cancel any order and/or refuse delivery upon default by
Contractor concerning time, cost, or manner of delivery.
Contractor will not be held responsible for unforeseen delays caused by fires, strikes, acts of God, or other causes beyond
Contractor’s control, provided that Contractor provide immediate notice of delay.
12. SPECIFICATION CHANGES:

COUNTY shall have the right to make changes in the specifications, services, or terms and conditions of an order. If such
changes cause an increase or decrease in the amount due under an order or in time required for performance, an
acceptable adjustment shall be made and the order shall be modified in writing. Any agreement for adjustment must be
made in writing. Nothing in this clause shall reduce Contractor’s’ responsibility to proceed without delay in the delivery or
performance of an order.
13. INSPECTION:
All goods and services are subject to inspection and testing at place of manufacture, the destination, or both, by
COUNTY. Goods failing to meet specifications of the order or contract shall be held at Contractor’s risk and may be
returned to Contractor with costs for transportation, unpacking, inspection, repacking, reshipping, restocking or other like
expenses to be the responsibility of Contractor. In lieu of return of nonconforming supplies, COUNTY, at its sole discretion
and without prejudice to COUNTY’s rights, may waive any nonconformity, receive the delivery, and treat the defect(s) as a
warranty item, but waiver of any condition shall not be considered a waiver of that condition for subsequent shipments or
deliveries.
14. SHIPPING TERMS:

Unless stated otherwise by the agreement documents, delivery terms are to be F.O.B. Destination & Freight Prepaid Not
Billed (“F.O.B. Destination”) are to be included in the Unit Price offered by Contractor and accepted by the COUNTY.
15. PAYMENT TERMS:

Payment terms are net 30, unless otherwise specified by the agreement documents.
16. ACCEPTANCE OF MATERIALS AND SERVICES:

COUNTY will not execute an acceptance or authorize payment for any service, equipment or component prior to delivery
and verification that all specification requirements have been met.
17. RIGHTS AND REMEDIES OF PIMA COUNTY FOR DEFAULT:

In the event any item furnished by the Contractor in the performance of the agreement should fail to conform to the
specifications thereof, or to the sample submitted by the Contractor, COUNTY may reject same, and it shall thereupon
become the duty of the Contractor to reclaim and remove the same, without expense to COUNTY, and immediately
replace all such rejected items with others conforming to the specifications or samples. Should the Contractor fail,
neglect, or refuse immediately to do so, COUNTY, shall have the right to purchase in the open market, in lieu thereof, a
corresponding quantity of any such items and to deduct from any monies due or that may become due to the Contractor
the difference between the price named in the contract or purchase order and actual cost to COUNTY. In the event the
Contractor shall fail to make prompt delivery as specified of any item, the same conditions as to the rights of COUNTY to
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PIMA COUNTY STANDARD TERMS AND CONDITIONS 07/30/09)
purchase in the open market and invoke the reimbursement condition above shall apply, except when delivery is delayed
by fire, strike, freight embargo, or acts of god or of the government. In the event of cancellation of the contract or purchase
order, either in whole or in part, by reason of the default or breach by the Contractor, any loss or damage sustained by
COUNTY in procuring any items which the Contractor agreed to supply shall be borne and paid for by the Contractor. The
rights and remedies of COUNTY provided above shall not be exclusive and are in addition to any other rights and
remedies provided by law or under the contract.
18. FRAUD AND COLLUSION:

Each Contractor, by submission of a bid, proclaims and agrees that no officer or employee of COUNTY or of any
subdivision thereof has: 1) aided or assisted the Contractor in securing or attempting to secure a contract to furnish labor,
materials or supplies at a higher price than that proposed by any other Contractor; 2) favored one Contractor over another
by giving or withholding information or by willfully misleading the bidder in regard to the character of the material or
supplies called for or the conditions under which the proposed work is to be done; 3) will knowingly accept materials or
supplies of a quality inferior to those called for by any contract; 4) any direct or indirect financial interest in the offer or
resulting agreement. Additionally, during the conduct of business with COUNTY, the Contractor will not knowingly certify,
or induce others to certify, to a greater amount of labor performed than has been actually performed, or to the receipt of a
greater amount or different kind of material or supplies that has been actually received. If at any time it shall be found that
the awardee(s) has in presenting any offer(s) colluded with any other party or parties for the purpose of preventing any
other offer being made, then the agreement so awarded shall be terminated and that person or entity shall be liable for all
damages sustained by COUNTY.
19. COOPERATIVE USE OF RESULTING AGREEMENT:

As allowed by law, the COUNTY has entered into cooperative procurement agreements that enable other Public Agencies
to utilize procurement agreements developed by the COUNTY. The Contractor may be contacted by participating
agencies and requested to provide services and products pursuant to the pricing, terms and conditions defined by the
COUNTY blanket contract, purchase order or contract. Minor adjustments are allowed subject to agreement by both
Contractor and Requesting Party to accommodate additional cost or other factors not present in the COUNTY agreement
and required to satisfy particular Public Agency code or functional requirements and are within the intended scope of the
solicitation and resulting agreement. Any such usage shall be in accordance with State, COUNTY and other Public
Agency procurement rules, regulations and requirements and shall be transacted by blanket contract purchase order or
contract between the requesting party and Contractor. Contractor shall hold harmless COUNTY, its officers, employees,
and agents from and against all liability, including without limitation payment and performance associated with such use. A
list of agencies that are authorized to use COUNTY agreements can be viewed at the Procurement Department Internet
home page: http://www.pima.gov/procure by selecting the link titled Authorized Use of COUNTY Agreements.
20. PATENT INDEMNITY:

Contractor shall hold COUNTY, its officers, agents and employees, harmless from liability of any nature or kind, including
costs and expenses, for infringement or use of any copyrighted composition, secret process, patented or unpatented
invention, article or appliance furnished or used in connection with the blanket contract purchase order or contract.
Contractor may be required to furnish a bond or other indemnification to COUNTY against any and all loss, damage,
costs, expenses, claims and liability for patent or copyright infringement.
21. INDEMNIFICATION:
Contractor shall indemnify, defend, and hold harmless COUNTY, its officers, employees and agents from and against any
and all suits, actions, legal administrative proceedings, claims or demands and costs attendant thereto, arising out of any
act, omission, fault or negligence by the Contractor, its agents, employees or anyone under its direction or control or on its
behalf in connection with performance of the blanket contract, purchase order or contract. Contractor warrants that all
products and services provided under this contract are non-infringing. Contractor will indemnify, defend and hold
COUNTY harmless from any claim of infringement arising from services provided under this contract or from the provision,
license, transfer or use for their intended purpose of any products provided under this Contract.
22. UNFAIR COMPETITION AND OTHER LAWS:

Responses shall be in accordance with Arizona trade and commerce laws (Title 44 A.R.S.) and all other applicable
COUNTY, State, and Federal laws and regulations.
9
23. COMPLIANCE WITH LAWS:

Contractor shall comply with all federal, state, and local laws, rules, regulations, standards and Executive Orders, without
limitation. The laws and regulations of the State of Arizona shall govern the rights, performance and disputes of and
between the parties. Any action relating to this Contract shall be brought in a court of the State of Arizona in COUNTY.
Any changes in the governing laws, rules, and regulations during an agreement shall apply, but do not require an
amendment/revisions.
24. ASSIGNMENT:
Contractor shall not assign its rights to the resultant agreement, in whole or in part, without prior written approval of the
COUNTY. Approval may be withheld at the sole discretion of COUNTY, provided that such approval shall not be
unreasonably withheld.
25. CONFLICT OF INTEREST:

All agreements are subject to the provisions of A.R.S. § 38-511, the pertinent provisions of which are incorporated into
and made part of all resultant contracts or purchase orders as if set forth in full herein.
26. NON-DISCRIMINATION:
CONTRACTOR agrees that during the performance of this contract, CONTRACTOR shall not discriminate
against any employee, client or any other individual in any way because of that person’s age, race, creed, color,
religion, sex, disability or national origin. CONTRACTOR shall comply with the provisions of Arizona Executive
Order 75-5, as amended by Executive Order 99-4, which is incorporated into this Contract as if set forth in full
herein.
27. NON-APPROPRIATION OF FUNDS:

Pursuant to the provisions of A.R.S. § 11-251, sub-section 42, this agreement may be canceled if for any reason the
COUNTY Board of Supervisors does not appropriate funds for the stated purpose of maintaining any agreement. In the
event of such cancellation, COUNTY shall have no further obligation, other than for services or goods that have already
been received.
28. PUBLIC INFORMATION:

Pursuant to A.R.S. § 39-121 et seq., and A.R.S. § 34-603(G) in the case of construction or Architectural and Engineering
services procured under A.R.S. Title 34, Chapter 6, all information submitted in response to this solicitation, including, but
not limited to, pricing, product specifications, work plans, and any supporting data becomes public information and upon
request, is subject to release and/or review by the general public including competitors.
Any records submitted in response to this solicitation that Contractor believes constitute proprietary, trade secret or
otherwise confidential information must be appropriately and prominently marked as CONFIDENTIAL by Contractor prior
to the close of the solicitation.
Notwithstanding the above provisions, in the event records marked CONFIDENTIAL are requested for public release
pursuant to A.R.S. § 39-121 et seq., COUNTY shall release records marked CONFIDENTIAL ten (10) business days after
the date of notice to the Contractor of the request for release, unless Contractor has, within the ten day period, secured a
protective order, injunctive relief or other appropriate order from a court of competent jurisdiction, enjoining the release of
the records. For the purposes of this paragraph, the day of the request for release shall not be counted in the time
calculation. Contractor shall be notified of any request for such release on the same day of the request for public release
or as soon thereafter as practicable.
COUNTY shall not, under any circumstances, be responsible for securing a protective order or other relief enjoining the
release of records marked CONFIDENTIAL, nor shall COUNTY be in any way financially responsible for any costs
associated with securing such an order.
29. CUSTOM TOOLING, DOCUMENTATION AND TRANSITIONAL SUPPORT:

Costs to develop all tooling and documentation, such as and not limited to dies, molds, jigs, fixtures, artwork, film,
patterns, digital files, work instructions, drawings, etc. necessary to provide the contracted services or products and are
unique to the services or products supplied to COUNTY are included in the agreed upon Unit Price unless specifically
stated otherwise in the agreement. It is agreed that such tools and documentation are the property of COUNTY and shall
10
be marked, as is practical, as the "Property of Pima County" and if requested by COUNTY a copy of the tooling and
documentation shall be delivered to COUNTY within twenty days of acceptance by the COUNTY of the first article
sample, or not later than ten days of termination of the agreement associated with their development, without additional
cost to COUNTY. The Contractor also agrees to act in good faith to facilitate the transition of work to a subsequent
Contractor if and as reasonably requested by COUNTY at no additional cost. Should exceptional circumstances be
present that may justify an additional charge, the Contractor may submit said justification and proposed cost and
negotiate an agreement acceptable to both Contractor and COUNTY, but Contractor may not withhold any requested
tooling, document or support as defined above that would delay the orderly, efficient and prompt transition of work. Should
conduct by the Contractor result in additional costs to the COUNTY the Contractor agrees to reimburse the COUNTY for
said actual and incremental costs provided that the COUNTY had given the Contractor reasonable time to respond to the
COUNTY's requests for support.
30. AMERICANS WITH DISABILITIES ACT:

Contractor shall comply with all applicable provisions of the Americans with Disabilities Act (public law 101-336, 42 USC
12101-12213) and all applicable federal regulations under the act, including 28 CFR parts 35 and 36.
31. NON-EXCLUSIVE:
Agreements resulting from this solicitation are non-exclusive and are for the sole convenience of Pima County which
reserves the right to obtain like goods and services from other sources for any reason.
32. PROTESTS:
An interested party may file a protest regarding any aspect of a solicitation, evaluation, or recommendation for award.
Protests must be filed in accordance with the Pima County Procurement Code, Section 11.20.010.
33. TERMINATION:
COUNTY reserves the right to terminate any blanket contract, purchase order, contract or award, in whole or in part, at
anytime, without penalty or recourse when in the best interests of the COUNTY, Upon receipt of written notice, Contractor
shall immediately cease all work as directed by the notice, notify all sub-Contractor of the effective date of termination and
take appropriate actions to minimize further costs to the COUNTY. In the event of termination under this paragraph, all
documents, data, and reports prepared by the Contractor under the contract shall become the property of and be promptly
delivered to the COUNTY. The Contractor shall be entitled to receive just and equitable compensation for work in
progress, work completed and materials accepted before the effective date of the termination. The cost principles and
procedures defined by A.A.C. R2-7-701 shall apply.
34. ORDER OF PRECEDENCE-CONFLICTING DOCUMENTS:

In the event that there are inconsistencies between agreement documents, following is the order of precedence, superior
to subordinate, that shall be applied to resolve the inconsistency: blanket contract; purchase order; offer agreement or
contract attached to a blanket contract or purchase order; standard terms and conditions; other solicitation documents.
35. INDEPENDENT CONTRACTOR:

The status of the Contractor shall be that of an independent Contractor. Neither Contractor nor Contractor officer’s agents
or employees shall be considered an employee of COUNTY or be entitled to receive any employment-related fringe
benefits under the COUNTY Merit System. Contractor shall be responsible for payment of all federal, state and local
taxes associated with the compensation received pursuant to this Contract and shall indemnify and hold
COUNTY harmless from any and all liability which COUNTY may incur because of Contractor’s failure to pay such taxes.
Contractor shall be solely responsible for program development and operation.
36. BOOKS AND RECORDS:

Contractor shall keep and maintain proper and complete books, records and accounts, which shall be open at all
reasonable times for inspection and audit by duly authorized representatives of COUNTY. In addition, Contractor shall
retain all records relating to this contract at least 5 years after its termination or cancellation or, if later, until any related
pending proceeding or litigation has been closed.
11
37. COUNTERPARTS:
The blanket contract, purchase order or contract awarded pursuant to this solicitation may be executed in any number of
counterparts and each counterpart shall be deemed an original, and together such counterparts shall constitute one and
the same instrument. For the purposes of the blanket contract, purchase order or contract, the signed offer of Respondent
and the signed acceptance of COUNTY shall each be deemed an original and together shall constitute a binding blanket
contract, purchase order or contract, if all other requirements for execution have been met.
38. AUTHORITY TO CONTRACT:

Contractor warrants its right and power to enter into the blanket contract, purchase order or contract. If any court or
administrative agency determines that COUNTY does not have authority to enter into the blanket contract, purchase order
or contract, COUNTY shall not be liable to Contractor or any third party by reason of such determination or by reason of
the blanket contract, purchase order or contract.
39. FULL AND COMPLETE PERFORMANCE:

The failure of either party to insist on one or more instances upon the full and complete performance with any of the terms
or conditions of the blanket contract, purchase order or contract to be performed on the part of the other, or to take any
action permitted as a result thereof, shall not be construed as a waiver or relinquishment of the right to insist upon full and
complete performance of the same, or any other covenant or condition, either in the past or in the future. The acceptance
by either party of sums less than may be due and owing it at any time shall not be construed as an accord and
satisfaction.
40. SUBCONTRACTOR:
CONTRACTOR shall be fully responsible for all acts and omissions of any subcontractor and of persons directly or
indirectly employed by any subcontractor, and of persons for whose acts CONTRACTOR may be liable to the same
extent that the CONTRACTOR is responsible for the acts and omissions of persons directly employed by it. Nothing in
this contract shall create any obligation on the part of COUNTY to pay or see to the payment of any money due any
subcontractor, except as may be required by law.
41. SEVERABILITY:
Each provision of this Contract stands alone, and any provision of this Contract found to be prohibited by law shall be
ineffective to the extent of such prohibition without invalidating the remainder of this Contract.
42. LEGAL ARIZONA WORKERS ACT COMPLIANCE

CONTRACTOR hereby warrants that it will at all times during the term of this Contract comply with all federal immigration
laws applicable to CONTRACTOR’s employment of its employees, and with the requirements of A.R.S. § 23-214 (A)
(together the “State and Federal Immigration Laws”). CONTRACTOR shall further ensure that each subcontractor who
performs any work for CONTRACTOR under this contract likewise complies with the State and Federal Immigration Laws.
COUNTY shall have the right at any time to inspect the books and records of CONTRACTOR and any subcontractor in
order to verify such party’s compliance with the State and Federal Immigration Laws.
Any breach of CONTRACTOR’s or any subcontractor’s warranty of compliance with the State and Federal Immigration
Laws, or of any other provision of this section, shall be deemed to be a material breach of this Contract subjecting
CONTRACTOR to penalties up to and including suspension or termination of this Contract. If the breach is by a
subcontractor, and the subcontract is suspended or terminated as a result, CONTRACTOR shall be required to take such
steps as may be necessary to either self-perform the services that would have been provided under the subcontract or
retain a replacement subcontractor, as soon as possible so as not to delay project completion.
CONTRACTOR shall advise each subcontractor of COUNTY’s rights, and the subcontractor’s obligations, under this
Article by including a provision in each subcontract substantially in the following form:
“SUBCONTRACTOR hereby warrants that it will at all times during the term of this contract comply with all federal
immigration laws applicable to SUBCONTRACTOR’s employees, and with the requirements of A.R.S. § 23-214 (A).
SUBCONTRACTOR further agrees that COUNTY may inspect the SUBCONTRACTOR’s books and records to insure
that SUBCONTRACTOR is in compliance with these requirements. Any breach of this paragraph by SUBCONTRACTOR
will be deemed to be a material breach of this contract subjecting SUBCONTRACTOR to penalties up to and including
suspension or termination of this contract.”
12
Any additional costs attributable directly or indirectly to remedial action under this Article shall be the responsibility of
CONTRACTOR. In the event that remedial action under this Article results in delay to one or more tasks on the critical
path of CONTRACTOR’s approved construction or critical milestones schedule, such period of delay shall be deemed
excusable delay for which CONTRACTOR shall be entitled to an extension of time, but not costs.
43. CONTROL OF DATA PROVIDED BY PIMA COUNTY:

For those projects and contracts where Pima County has provided data to enable the Contractor to provide contracted
services or products, unless otherwise specified and agreed to in writing by Pima County, Contractor shall treat, control
and limit access to said information as confidential and under no circumstances release any data provided by County
during the term of this agreement and thereafter, including but not limited to personal identifying information as defined by
A.R.S. § 44-1373, and is further prohibited from selling such data directly or through a third party. Upon termination of the
associated agreement or completion of the required contractual intent whichever occurs sooner, Contractor shall either
return all data to County or shall destroy such data and confirm destruction in writing in a timely manner not to exceed 60
calendar days.
END OF PIMA COUNTY STANDARD TERMS AND CONDITIONS

(July 30, 2009)
13
SPECIFIC TERMS AND CONDITIONS
1. INTENT:
Pima County is seeking proposals from qualified Offerors to provide comprehensive Pharmacy Benefit Manager (PBM)
and Pharmacy Services for Pima Health System (“PLAN”) members for a one (1) year period beginning June 1, 2010 to
May 31, 2011, with the option to renew by mutual agreement for four (4) additional one (1) year periods.
Proposals will be considered only from respondents that are established pharmacy benefit managers and those, in the
judgment of the County, are financially responsible and able to show evidence of their reliability, ability, experience,
equipment, facilities and personnel directly employed or supervised by them, and to render prompt and satisfactory
service.
This proposal shall establish a per paid claim transaction rate for PBM services and reimbursement rates for prescription
drug services for the Arizona Long Term Care System (ALTCS), Arizona Health Care Cost Containment System
(AHCCCS), Pima County eligible members, and any future groups of members receiving health care services through
Pima Health System.
2. PIMA HEALTH SYSTEM SERVICES:

Pima Health System (PHS) is an entity of Pima County Government operated as an enterprise fund under the authority of
the Pima County Board of Supervisors. PHS is under the administration of the Pima Health System Executive Officer and
receives administrative support from various County Departments. PHS operates three divisions as follows:
2.1. Ambulatory Medical Care: An acute/ambulatory managed care plan under AHCCCS, Arizona Health Care Cost
Containment System. Please see Attachment A for additional information which includes full AHCCCS
benefited members and Family Planning Only Members. This plan serves both Pima and Santa Cruz Counties.
2.2 Long Term Care: a Long Term Care (LTC) program under ALTCS, Arizona Long Term Care System. LTC
includes both, 1) skilled nursing facility population; 2) home and community based services population in both
Pima and Santa Cruz Counties. Please see Attachment B for additional information.
2.3 Coordination of Benefits: Dually enrolled members with a primary insurance that is other than the PLAN.
PHS utilizes the medical services of Posada Del Sol skilled nursing facility, and other entities of PHS and Pima County
Government. PHS also utilizes the services of numerous contracted independent health care providers, group practices,
skilled nursing facilities, assisted living centers and facilities throughout Pima and Santa Cruz Counties.
Enrollment for all PHS programs is found in Attachment C.
3. SPECIFICATIONS:
All goods and services shall conform to the Instructions to Offerors, and Standard Terms and Conditions as modified or
added to by the Sample Agreement.
In addition, proposer shall review the following documents and provide evidence that your company is committed and
capable of meeting Pima Health System claim and reporting system.
3.1 Attachment D Pharmacy Benefit Managers File Exchange Overview
3.2 Attachment E Pharmacy Benefit Manager (PBM) File Requirements
3.3 Attachment F On-Line Electronic Claim Requirement
3.4 Attachment G Plan Member Eligibility File Layout
3.5 Attachment H Prescriber Provider File Layout
3.6 Attachment I Paid Claim Proprietary File Layout
3.7 Attachment J Paid Claim 3.2 File Layout
3.8 Attachment K Current Plan Contracted Pharmacies (Note: Pharmacy providers may change and are
controlled by the PLAN via separate agreements)
14
SPECIFIC TERMS AND CONDITIONS (Continued)
3.9 Attachment L Utilization and Member Enrollment
4. SAMPLE AGREEMENT:
A copy of the Sample Agreement is included for review. Each respondent, by submitting a proposal, will be certifying that
the Sample Agreement is acceptable as written, unless exceptions are taken and specific alternate language proposed.
Exceptions which include language unacceptable to Pima County may be cause for the respondent’s proposal to be
rejected as Non-Responsive and not evaluated. The Agreement will be entered into by and between Pima County and the
successful respondent. Pima County reserves the right to negotiate any terms or conditions if it is determined to be in the
best interest of the County. It is not necessary to return sample agreement.
5. PRICING
Respondents shall offer pricing in the precise manner requested on the Exhibit B: Proposal Pricing Sheet.
6. CERTIFICATION FORM:
The certification form must be completed and signed by the respondent. Failure to complete and sign this form shall be
cause for respondent’s proposal to be rejected.
7. COMPENSATION & PAYMENT:

PHS will pay for services when they are prior authorized (if required) and the patient remains an eligible member of PHS.
PHS is not responsible for payment if patient loses eligibility or if member has other primary insurance, in which the
pharmacy service is a covered benefit.
Price Warranty & Adjustment: It is the intention of both parties that pricing shall remain firm during the term of the
agreement. County shall only consider price increases in conjunction with a renewal of the agreement. In the event that
economic conditions are such that unit price increases are desired by the Offeror upon renewal of the agreement, Offeror
shall submit a written request to Pima County Procurement Department with supporting documents justifying such
increases at least 90 days prior to the termination date of the agreement. It is agreed that the Unit Prices shall include
compensation for the Offeror to implement and actively conduct cost and price control activities, and in its request for
price increases Offeror shall cite sources, specific conditions and document how those conditions affect the cost of its
performance, and specific efforts Offeror has taken to control and reduce costs. COUNTY will review the proposed
pricing and determine if it is in the best interest of COUNTY to extend the agreement.
Quantities referred to are estimated quantities. Pima County reserves the right to increase or decrease the quantities and
amounts. No guarantee is made regarding actual orders issued for items or quantities during the term of the agreement.
Pima County shall not be responsible for Offeror inventory or order commitment.
Unit Prices offered shall include all incidental and associated costs required to comply with and satisfy all requirements
referred to or included in this solicitation which includes the Instructions to Offerors, Standard Terms and Conditions and
Exhibit A: Offer Agreement. No payments will be made for items not included in the agreement.
END OF SPECIFIC TERMS AND CONDITIONS
15
ATTACHMENT A
AMBULATORY MEDICAL CARE
PHS competitively bids as a managed care provider for Medicaid services under the Arizona Health Care Cost Containment
System (AHCCCS) to serve Pima and Santa Cruz County. The present AHCCCS bid resulted in a five year contract
beginning October 1, 2008 and was one of five awarded in Pima County. As an AHCCCS provider since 1982, PHS is
responsible for providing health care services which comply with all Title XIX and AHCCCS rules and regulations. These
regulations dictate which services must be covered and require utilization and quality management of resources to ensure
that quality cost-effective services are provided. PHS contracts, standards and procedures, medical standards and quality
management activities reflect and incorporate these rules and regulations. PHS is organized and staffed to supply the
medical, fiscal, administrative and support services necessary to establish and manage the mandated network of health care
services.
A. ELIGIBILITY: Eligibility criteria for members in the acute medical care plan is established by AHCCCS and determined
by four (4) agencies for the various coverage groups:
- Social Security Administration (SSA) - determines eligibility for the Supplemental Security Income (SSI) cash
program whose recipients are automatically eligible for AHCCCS coverage.
- Department of Economic Security (DES) - determines eligibility for the Assistance for Families, Pregnant Women
and Children (AFPC) cash program (recipients are automatically eligible for AHCCCS), TANF and SSI Medical
Assistance Only (MAO) groups. Under the AFPC umbrella, are two categories:
AFC (AHCCCS for Families with Children) Cash, formerly known as TANF - Cash:
AFPC - Medical Assistance Only (MAO), formerly known as TANF - Medical Assistance Only. This category
includes SOBRA Pregnant Women, SOBRA Children, Ribicoff Children, IVE Foster Care and Adoption Assistance*,
and Transitional Medical Assistance.
*Children receiving foster care or adoption subsidy payments under Title IV-E of the Social Security Act are
considered categorically eligible.
- State Program “KidsCare” - program under Title XXI that determines medical eligibility for children under the age of
19 who do not meet the income requirements for other state and federally funded programs. Limited benefits
package. KidsCare members do not have the same array of benefits as members of other coverage groups.
B. MEMBER ASSIGNMENT: Each member determined eligible for services is assigned a PCP through choice or
automatic assignment to a contracted provider in his/her geographic area within 10 days of enrollment. When new
members are assigned to PHS they are provided with information about PHS and informed about their right to select any
clinic or health center in the PHS network and any contracted Primary Care Provider (PCP) associated with that clinic. If
a member fails to select a PCP, PHS will assign the member to a PCP according to a default system based on the
member's zip code. The PCP serves as the gatekeeper for all services.
C. PROVIDER NETWORK: PHS has established and maintains a provider network that meets the medical and
geographic needs of its assigned membership. Currently there are 100 clinics/doctors and almost 400 PCPs under
contract in Tucson and the outlying rural areas of Pima County. The network also includes medical specialists, dental
clinics and over 100 pharmacy locations. PHS uses the inpatient services of all 15 area hospitals.
D. AHCCCS AMBULATORY CENSUS: Enrollment statistics are included in Attachment C. The enrollment information
for this group is entitled AHCCCS Ambulatory.
END OF ATTACHMENT A
16
ATTACHMENT B
LONG TERM CARE
Pima County has been mandated by State Legislation to be a "Program Contractor" for the Arizona Long Term Care System
(ALTCS) Medicaid Program in Pima County since 1989. In 2006, PHS won a competitive bid as the sole provider for ALTCS
services in Pima and Santa Cruz County. This bid resulted in a five year contract beginning October 2006. ALTCS eligibility
is based on both financial need and disability level as defined by the Federal Government. ALTCS services include medical
services, skilled nursing care, and a variety of home and community based services. Each member is assigned a primary
care provider (PCP) and a case manager who cooperates to order, coordinate and ensure appropriate medical and other
long term care services. Nursing home care is provided through contracts with 22 nursing facilities in Tucson, Green Valley,
Nogales and Phoenix with specialty care services provided at Posada Del Sol Health Care Center and Santa Rosa Skilled
Nursing Facility. Home and Community Based Services (HCBS) are contracted and designed to assist members to remain
independent and continue living in the community and include:
-Adult Day Health Care -Home Health Aide

-Adult Foster Care -Home Health Nurse
-Assisted Living Facility -Home Repair & Adaptation
-Attendant Care -Housekeeper services
-Case Management services -Personal Care
-Emergency Response System -Respite
-Health and Medical services -Transportation (Non Emergency Medical)
-Home Delivered Meals
A. ELIGIBILITY: To be eligible for ALTCS services a person must meet the following requirements established by the
ALTCS Administration:
- U.S. citizen or legal alien status

- Resident of Arizona
- Verifiable Social Security Number
- ALTCS medical and financial requirements
Eligibility is determined by the State ALTCS eligibility office and members are assigned to the program contractor in their
area.
B. MEMBER ASSIGNMENT: When a member is determined eligible and assigned to PHS Long Term Care (LTC), the
member must be placed in the appropriate service within 30 days. The initial placement is made to the least restrictive
setting and is based on the member/family preference, the appropriateness of the care setting in meeting the member's
needs, and the cost-effectiveness of the setting. Members may be placed in an Institutional or HCBS setting. HCBS
may include Adult Living Facilities (Assisted Living Homes, Assisted Living Centers and Adult Foster Care) or Home
services only. Of the LTC population, 65% are placed in HCBS and 35% are placed in Institutional settings.
C. PROVIDER NETWORK: PHS LTC maintains a network of providers to meet the medical and Long Term Care needs of
assigned members. The ambulatory network provides medical services. As of December 2009, the Long Term Care
services are provided by a network of 22 contracted nursing facilities, 8 assisted living centers, 98 assisted living homes,
24 licensed foster care homes and 29 home care agencies. Other home and community based services are obtained
through contracts with community agencies
D. PHS LTC CENSUS: Enrollment statistics in the LTC Program is included in the LTC Business Lines of Attachment C.
END OF ATTACHMENT B
17
ATTACHMENT C
PIMA HEALTH SYSTEM
MEMBER ENROLLMENT
CY 08-09
GROUP 10/01/08 11/01/08 12/01/08 01/01/09 02/01/09 03/01/09 04/01/09 05/01/09 06/01/09 07/01/09 08/01/09 09/01/09
AHCCCS ACUTE P.C. 2,675 2,563 2,588 2,404 2,345 2,306 2,257 2,208 2,161 2,153 2,134 2,084
AHCCCS ACUTE S.C.C. 85 0 0 0 0 0 0 0 0 0 0 0
TOTAL ACUTE 2,760 2,563 2,588 2,404 2,345 2,306 2,257 2,208 2,161 2,153 2,134 2,084
ALTCS P.C. 3,864 3,901 3,923 3,921 3,938 3,933 3,969 3,951 3,937 3,934 n/a n/a
ALTCS S.C.C. 240 240 240 246 250 253 255 259 266 268 n/a n/a
TOTAL ALTCS 4,104 4,141 4,163 4,167 4,188 4,186 4,224 4,210 4,203 4,202 4,241 4,244
MEDICAL TOTAL 6,864 6,704 6,751 6,571 6,533 6,492 6,481 6,418 6,364 6,355 6,375 6,328
MEDICAL TOTAL 6,864 6,704 6,751 6,571 6,533 6,492 6,481 6,418 6,364 6,355 6,375 6,328
CY 09-10
GROUP 10/01/09 11/01/09 12/01/09 01/01/10 02/01/10 03/01/10 04/01/10 05/01/10 06/01/10 07/01/10 08/01/10 09/01/10
AHCCCS ACUTE P.C. 2,057 2,019
TOTAL ACUTE 2,057 2,019
ALTCS P.C. 3,969 3,967
ALTCS S.C.C. 276 289
TOTAL ALTCS 4,245 4,256
MEDICAL TOTAL 6,302 6,275
TOTAL 6,302 6,275
END OF ATTACHEMENT C
18 of 72
ATTACHMENT D
PHARMACY BENEFIT MANAGERS FILE EXCHANGE OVERVIEW
Paid Claims Proprietary File

** Prescriber Provider file
Pharmacy Remittance 835
Paid Claims NCPDP32 file

Plan Member Eligibility file
21
ATTACHMENT E
PHARMACY BENEFIT MANAGERS (PBM) FILE REQUIREMENTS
Plan Member Eligibility File

Frequency: Daily
This is a PHS outgoing file requirement is to satisfy the PBM requirements to validate member eligibility. This file is full file
replacement file. Contains full membership enrollment, members are disenrolled by being absent from this file.
Prescriber Provider File**

Frequency: Weekly
This is a PHS outgoing file requirement is to satisfy the PBM requirements to validate prescriber provider eligibility in a
closed prescriber provider network.
** Prescriber provider data file will be used if Plan decides to have a closed prescriber provider network
Paid Claim Proprietary File

Frequency: Encounter Cycle
This is a PBM outgoing file requirement is to satisfy the Arizona Health Care Cost Containment System (AHCCCS) Health
Information Exchange (HIE) AMIE project (Arizona Medical Information Exchange).
Managed Care Pharmacy Consultants is a sub-contractor for the AMIE project.

PBM that are contracted with Medicaid provide medication history files to MCPC. MCPC processes the medication
records and applies intelligence to associate them with the proper patients, and publishes the demographics to AMIE. The
medication histories are then available for viewing by AMIE users in the same manner as hospital discharge summaries
are made available by participating hospitals.
Paid Claim NCPDP 3.2 File

This is a PBM outgoing file requirement is to satisfy the PLANS claim billing system. Although the newer standard
NCPDP 5.1 is available, PHS EDI uses NCPDP 3.2. PLAN may elect to switch to NCPDP 5.1 in the future and requires
PBM to be able to produce Claims Billing NCPDP 5.1 files.
Pharmacy Remittance 835 File

This is a PLAN outgoing file. PLAN shall make efforts to provide pharmacy remittance advices in HIPPA Compliant 835
files.
END OF ATTACHMENT E
22
ATTACHMENT F
ON-LINE ELECTRONIC CLAIM REQUIREMENTS
PROCESSING REQUIREMENTS:
Multiple Groups/Benefit Plans
• Maintain a variety of groups and benefit plans, each with a specific member list, pharmacy providers, medical
providers and plan design.
Member Eligibility
• Verification that member is eligible on the date the prescription is filled.
• Verify eligibility by matching the member identification number, age and gender of the member submitted by the
processing pharmacy to the member eligibility file provided by Pima Health System.
• Must be able to support multiple date sensitive enrollment segments which may cross between multiple groups within
the health plans.
• Must be able to link members who have previous ID# (i.e., Social Security # changed to AHCCCS ID #).
Pharmacy Provider Eligibility

• Maintain a list of approved pharmacy providers. Maintain NABP and NPI numbers for these approved pharmacy
providers. Each member group within the health plan may have a specific list of eligible provider pharmacies.
Medical Prescriber Provider Eligibility

• Perform the check digit on the DEA and NPI number (if that is the unique identifier used) to ensure a valid DEA and
NPI number for the prescribing provider.
• Maintain a list of approved medical prescribing providers (or an exclusionary) list for each member group within the
health plan.
• Maintain crosswalk AHCCCS Provider ID to DEA# in order to populate pharmacy claim with prescribing Provider ID#.
Medication Inclusion or Exclusion

• Verify that a medication submitted by a processing pharmacy is on the health plan formulary for the members group.
• Provide member specific inclusion (prior authorization) and exclusion (denial) for medications.
• Verify that the NDC number submitted by the processing pharmacy is a valid number.
• Verify that the medication submitted is able to be filled/refilled as determined by the specific plan limitations for the
member group, by checking the claims history for duplicate prescriptions and the calculated days supply.
• Provide medication specific limitations i.e. maximum quantity or days supply different than general plan limits.
• Provide mandatory generic substitution requirements, except where specifically excluded by the health plan.
• Provide manufacturer specific limitations for marketed products.
• Provide local message that includes prior authorization expiration date.
Pricing
• Pay the provider pharmacy the appropriate amount for the submitted claim based upon the contracted rate for the
member’s group and/or any special pricing arrangements established with the provider pharmacy.
• Calculate the appropriate amount to pay the pharmacy based upon AWP discounted amount + dispensing fee or MAC
+ dispensing fee or the lower amount submitted by the provider pharmacy.
Following completion of a processed claim, return to the provider pharmacy:

• Unique claim authorization number
• Status of the claims
∗ Paid (amount to be paid to the pharmacy)
∗ Denial [reason for the denial (either in numeric code or text message, i.e., non-formulary medication, member
not eligible, pharmacy participation not established, etc.)]
(Customize reject messages)
END OF ATTACHMENT F
23
ATTACHMENT G
PLAN MEMBER ELIGIBILITY FILE LAYOUT
Field Name Start Width Field Name Start Width
Carrier 1 9 ClientRiderCode 321 6

Account 10 15 CareFromDate 327 7
Group 25 15 CareThruDate 334 7
MemberID 40 18 CareNetwork 341 10
PersonCd 58 3 CareFacility 351 6
RelationshipCd 61 1 CareQualifier 357 10
LastName 62 25 PcpId 367 10
FirstName 87 15 AltInsFlag 377 1
MiddleInitial 102 1 AltInsCd 378 10
Sex 103 1 AltInsId 388 18
DateOfBirth 104 8 CardFlag 406 1
MultiBirthCode 112 1 filler1 407 40
MemberType 113 1 MedCvgType 447 1
LanguageCode 114 1 MedFromDate 448 7
DurFlag 115 1 MedicareHic 455 11
DurKey 116 18 DiagCd1 466 6
SocSecNbr 134 9 DiagCd2 472 6
Address1 143 25 DiagCd3 478 6
Address2 168 15 DiagCd4 484 6
City 183 20 DiagCd5 490 6
State 203 2 DiagCd6 496 6
Zip 205 5 DiagCd7 502 6
Zip2 210 4 DiagCd8 508 6
Zip3 214 2 DiagCd9 514 6
Country 216 4 DiagCd10 520 6
Phone 220 10 AllergyCd1 526 3
FamilyFlag 230 1 AllergyCd2 529 3
FamilyType 231 1 AllergyCd3 532 3
FamilyId 232 18 AllergyCd4 535 3
OrigFromDate 250 7 AllergyCd5 538 3
BenefitResetDate 257 7 AllergyCd6 541 3
FromDate 264 7 Height 544 5
ThruDate 271 7 Weight 549 5
Plan 278 10 BloodType 554 1
PlanEffDate 288 7 ContractLensCode 555 1
Brand 295 5 SmokingCode 556 1
Generic 300 5 PregnancyCode 557 1
Copay3 305 5 AlcoholCode 558 1
Copay4 310 5 MiscCode1 559 1
ClientProductCode 315 6 MiscCode2 560 1
Filler2 561 40
END OF ATTACHMENT G
24
ATTACHMENT H
PRESCRIBER PROVIDER FILE LAYOUT**
FieldName Start Width
PrescriberNpi*** 1 10
LastName 11 25
FirstName 36 15
Initial 51 1
DeaPrefix 52 2
DeaCode 54 7
DeaSuffix 61 4
Phone 65 10
Address 75 25
City 100 20
Zipcode 120 10
State 130 2
License 132 9
SpecialtyCode 141 6
MdNetworkId 147 6
PlanPrescriberId**** 153 15
** Prescriber provider data file will be used if Plan decides to have a closed prescriber provider network
*** Field “PrescriberNpi”, first field has been redefined from holding the PLAN’s provid to holding the prescriber’s NPI
value.
**** Field “PlanPrescriberId” has been added to hold the PLAN’s provid.
END OF ATTACHMENT H
25
ATTACHMENT I
PAID CLAIM PROPIETARY FILE LAYOUT
cols len field name description

1-12 12 MemberID member AHCCCS number
13-14 2 filler
15-28 14 LastName member last name
29-42 14 FirstName member first name
43 1 MiddleInit member middle initial
44-51 8 BirthDate member dob
52 1 Gender member sex
53-54 2 member age
55-64 10 Group
65-66 2 filler
67-70 4 RateCode member rate code (3 digits and a dash, most are
blank)
71-72 2 County member county code
73-76 4 filler
77-83 7 PharmacyID pharmacy’s DEA ID number
84-90 7 PlanID plan ID number (client number in eligibility files
sent to ComCoTec)
91-95 5 filler
96-101 6 ProviderID provider AHCCCS ID number
102-103 2 filler
104-123 20 PharmacyName pharmacy name
124-128 5 PharmacyZip pharmacy zip code
129-135 7 RxNumber prescription number (script number)
136-143 8 DateFilled date prescription filled
144 1 RefillNewFlag refill/new indicator, 1-new, 2-refill
145-154 10 PreAuthNumber pre-authorization number (mostly all zeroes)
155-156 2 filler
157 1 DispenseAsWrittenFlag submitted dispense as written indicator
158-160 3 DaysSupply applied days supply
161-166 6 MetricQuantity applied metric quantity 9(5)V91
167-173 7 IngredientCost applied ingredient cost 9(5)V992
174-179 6 DispenseFee applied dispense fee 9(4)V992

180-186 7 CoPay applied co-pay 9(5)V992
187-193 7 Balance applied balance 9(5)V992
194-200 7 AmountBilled amount billed 9(5)V992
201-211 11 NDCMfgCode NDC number2, manufacturer code
… NDCProductCode … , product code
… NDCPkgSizeCode … , package size code
1
V represents an implied decimal point, no actual decimal point is present in the data.
2
Field is 6 characters of data followed by 5 spaces.
26
ATTACHMENT I
PAID CLAIM PROPIETARY FILE LAYOUT
(Continued)
cols len field name description

212-239 28 DrugName drug brand name
240-245 6 DrugStrength drug strength (description)
246-251 6 TherapeuticClass therapeutic class - AHFS
252 1 MONYCode brand/generic code
253 1 NDC_DEACode NDC/DEA controlled drug code
254-260 7 filler
261-272 12 AlternateID Alternate ID (all zeroes)
273-312 40 filler
313-321 9 PrescriberID prescribing physician AHCCCS ID number
322-349 28 PrescriberName prescribing physician name (usually blank)
350-355 6 SalesTax applied sales tax 9(4)V992
356-363 8 FinancialCutOffDate financial cut-off date
364-371 8 ProcessDate run date
372-383 12 ClaimNumber claim number
384 1 DrugForm drug dosage form code
385 1 DrugMaintenanceFlag drug maintenance indicator
386 1 CompoundFlag compound drug indicator
387 1 MACFlag MAC indicator
388-394 7 filler
395 1 record identifier
END OF ATTACHMENT I
27
ATTACHMENT J
PAID CLAIM NCPDP 3.2 FILE LAYOUT
Seq Pos RecordType FieldName DataType DataFormatFileDataType Starting Ending Length

0 NULL HEADER Seg TEXT TEXT 1 2 2
1 0 HEADER hTransType TEXT TEXT 3 3 1
2 1 HEADER hSenderId TEXT TEXT 4 27 24
3 2 HEADER hBatchNbr INT 00000 TEXT 28 32 5
4 3 HEADER hCreateDate DATETIME CCYYMMDDhhmm TEXT 33 44 12
5 4 HEADER hFileType TEXT TEXT 45 45 1
6 5 HEADER hVersion TEXT TEXT 46 47 2
7 NULL HEADER Filler01 TEXT TEXT 48 1000 953
0 NULL DETAIL Seg TEXT TEXT 1 2 2
1 0 DETAIL TransNbr TEXT TEXT 3 12 10
2 1 DETAIL BinNbr TEXT TEXT 13 18 6
3 2 DETAIL VerNbr TEXT TEXT 19 20 2
4 3 DETAIL TransCode TEXT TEXT 21 22 2
5 4 DETAIL Pcn TEXT TEXT 23 32 10
6 5 DETAIL PharmacyNbr TEXT TEXT 33 44 12
7 6 DETAIL GroupNbr TEXT TEXT 45 59 15
8 7 DETAIL CardHolderId TEXT TEXT 60 77 18
9 8 DETAIL PersonCode TEXT TEXT 78 80 3
10 9 DETAIL DOB DATETIME CCYYMMDD TEXT 81 88 8
11 10 DETAIL Sex TEXT TEXT 89 89 1
12 11 DETAIL Relation TEXT TEXT 90 90 1
13 12 DETAIL OthCoverage TEXT TEXT 91 91 1
14 13 DETAIL DateFilled DATETIME CCYYMMDD TEXT 92 99 8
15 NULL DETAIL Filler01 TEXT TEXT 100 102 3
16 14 DETAIL CustLocation TEXT TEXT 103 104 2
18 15 DETAIL EligibiltyCode TEXT TEXT 108 108 1
20 16 DETAIL FirstName TEXT TEXT 112 123 12
22 17 DETAIL LastName TEXT TEXT 127 141 15
24 18 DETAIL RxNumber TEXT TEXT 143 149 7
36
Seq Pos RecordType FieldName DataType DataFormat FileDataType Starting Ending Length
25 19 DETAIL RefillNewFlag TEXT TEXT 150 151 2
26 20 DETAIL MetricQty INT 00000 TEXT 152 156 5
27 21 DETAIL DaysSupply INT 000 TEXT 157 159 3
28 22 DETAIL CompoundCode TEXT TEXT 160 160 1
29 23 DETAIL NDC TEXT TEXT 161 171 11
30 24 DETAIL DispAsWritten TEXT TEXT 172 172 1
31 25 DETAIL IngrCost MONEY 000000.00 TEXT 173 180 8
32 26 DETAIL PrescriberIdQual TEXT TEXT 181 182 2
33 27 DETAIL PrescriberId TEXT TEXT 183 192 10
34 28 DETAIL DateWritten DATETIME CCYYMMDD TEXT 193 200 8
35 29 DETAIL UCCharge MONEY 000000.00 TEXT 201 208 8
37 30 DETAIL PAMCCodeNbr TEXT TEXT 212 223 12
39 31 DETAIL LevelService TEXT TEXT 227 228 2
41 32 DETAIL Diag1 TEXT TEXT 232 237 6
43 33 DETAIL UnitDoseInd TEXT TEXT 241 241 1
45 34 DETAIL GrossAmtDue MONEY 000000.00 TEXT 245 252 8
47 35 DETAIL OtherPayerAmt MONEY 000000.00 TEXT 256 263 8
49 36 DETAIL PatientPaidAmt MONEY 000000.00 TEXT 267 274 8
51 37 DETAIL IncentiveAmt MONEY 0000.00 TEXT 278 283 6
53 38 DETAIL DurCode TEXT TEXT 287 288 2
55 39 DETAIL DURIntCode TEXT TEXT 292 293 2
57 40 DETAIL DUROutCome TEXT TEXT 297 298 2
59 41 DETAIL MetricDecimalQty NUMERIC 000000.00 TEXT 302 309 8
37
61 42 DETAIL PrimaryEOBDate DATETIME CCYYMMDD TEXT 313 320 8
62 43 DETAIL AhcccsId TEXT TEXT 321 329 9
64 44 DETAIL ReSubRefNbr TEXT TEXT 331 344 14
65 45 DETAIL PbmUniqueKey TEXT TEXT 345 364 20
66 46 DETAIL TribeId TEXT TEXT 365 370 6
67 47 DETAIL PregInd TEXT TEXT 371 371 1
68 48 DETAIL OtherProcCode TEXT TEXT 372 390 19
69 49 DETAIL Mod1 TEXT TEXT 391 392 2
75 55 DETAIL RefillsAuthorized TEXT TEXT 429 430 2
76 56 DETAIL PlanClaimNbr TEXT TEXT 431 450 20
77 57 DETAIL UnitMeasure TEXT TEXT 451 452 2
78 58 DETAIL CardHoldFirstName TEXT TEXT 453 464 12
79 59 DETAIL CardHoldLastName TEXT TEXT 465 479 15
80 60 DETAIL PATypeCode TEXT TEXT 480 481 2
81 61 DETAIL PANumberSubmitted TEXT TEXT 482 493 12
82 62 DETAIL DispFee MONEY 000000.00 TEXT 494 501 8
83 63 DETAIL SmokerInd TEXT TEXT 502 502 1
84 64 DETAIL Pay1CovType TEXT TEXT 503 504 2
85 65 DETAIL Pay1Id TEXT TEXT 505 514 10
86 66 DETAIL Pay1AllowAmt MONEY 000000.00 TEXT 515 522 8
87 67 DETAIL Pay1PaidAmt MONEY 000000.00 TEXT 523 530 8
88 68 DETAIL Pay1DispFee MONEY 000000.00 TEXT 531 538 8
89 69 DETAIL Pay1IngCost MONEY 000000.00 TEXT 539 546 8
90 70 DETAIL Pay1CoPay MONEY 000000.00 TEXT 547 554 8
91 71 DETAIL Pay1Deductible MONEY 000000.00 TEXT 555 562 8
92 72 DETAIL Pay1CoInsAmt MONEY 000000.00 TEXT 563 570 8
38
0 NULL TRAILER Seg TEXT TEXT 1 2 2
1 0 TRAILER tBatchNbr TEXT TEXT 3 7 5
2 1 TRAILER tRecordCount TEXT TEXT 8 17 10
3 2 TRAILER tGrossBilledAmt MONEY 0000000.00 TEXT 18 26 9
4 NULL TRAILER Filler01 TEXT TEXT 27 1000 974
END OF ATTACHMENT J
39
ATTACHMENT K
CURRENT PLAN CONTRACTED PHARMACIES
STORE ADDRESS CROSS STREETS AREA ZIP PHONE

FRY'S PHARMACY #17 4150 E. 22ND ST. 22ND ST. & ALVERNON CENTRAL 85711 571-2080
FRY'S PHARMACY #18 10661 N. ORACLE ROAD ORACLE & 1ST AVE. ORO VALLEY 85737 742-6667
FRY'S PHARMACY #19 3920 E. GRANT RD. GRANT & ALVERNON CENTRAL 85712 323-2695
FRY'S PHARMACY #20 3640 S. 16TH AVENUE 16TH & AJO (I-19) SOUTHWEST 85714 624-6936
FRY'S PHARMACY #21 555 E. GRANT GRANT & 1ST NORTH 85705 628-9428
FRY'S PHARMACY #33 7050 E. GOLF LINKS GOLF LINKS & KOLB EAST 85730 745-3003
FRY'S PHARMACY #34 7812 E. SPEEDWAY BLVD. SPEEDWAY & PANTANO EAST 85710 885-3540
FRY'S PHARMACY #36 3770 W. INA ROAD INA & THORNYDALE NORTHWEST 85741 744-2777
FRY'S PHARMACY #42 9401 E. 22ND STREET 22ND & HARRISON EAST 85710 721-9250
FRY'S PHARMACY #57 7870 N. SILVERBELL SILVERBELL & CORTARO MARANA 85743 744-7832
FRY'S PHARMACY #58 2001 E. IRVINGTON CAMPBELL & IRVINGTON SOUTHWEST 85714 294-7165
FRY'S PHARMACY #90 8080 S. HOUGHTON RD HOUGHTON & VALENCIA SOUTHEAST 85747 663-1961
FRY'S PHARMACY #117 10450 N. LA CANADA DR. LA CANADA & LAMBERT ORO VALLEY 85737 877-9269
FRY'S PHARMACY #119 902 W. IRVINGTON ROAD IRVINGTON & 12TH SOUTHWEST 85714 889-6551
FRY'S PHARMACY #131 2480 N. SWAN ROAD SWAN & GRANT CENTRAL 85712 327-7016
FRY'S PHARMACY #137 7050 E. 22ND STREET 22ND & KOLB EAST 85710 790-9492
FRY'S PHARMACY #138 4036 N. 1ST AVE. 1ST & ROGER NORTH 85719 293-8997
UPH AT KINO PHARMACY * 2800 E. AJO WAY AJO & PALO VERDE SOUTHWEST 85713 741-4002
UMC OUTPATIENT PHARMACY 1501 N. CAMPBELL STE. 2401 SPEEDWAY & CAMPBELL CENTRAL 85724 694-7049
APOTHECARY SHOPPE 2850 N. SWAN RD STE 110 SWAN & GLENN CENTRAL 85712 918-0044
2181 W ORANGE GROVE RD STE
APOTHECARY SHOPPE II 135 ORANGE GROVE & LA CHOLLA NORTHWEST 85741 797-7799
BASHA'S #52 UNITED DRUGS 15310 N. ORACLE RD. GOLDER RANCH & ORACLE NORTHWEST 85739 575-7301
BASHA'S #71 UNITED DRUGS 6900 E. SUNRISE DRIVE KOLB & SUNRISE NORTHEAST 85718 299-3378
BASHA'S #79 UNITED DRUGS 8360 N. THORNYDALE CORTARO & THORNYDALE NORTH 85741 744-1370
BASHA'S #100 UNITED DRUGS 3275 N. SWAN RD. CAMP LOWELL & SWAN CENTRAL 85712 323-5821
BASHA'S #125 UNITED DRUGS 13005 N. ORACLE RD. RANCHO VISTOSO & ORACLE NORTHWEST 85739 818-6468
BASHA'S #160 UNITED DRUGS 2000 W RIVER RD RIVER & LA CHOLLA NORTHWEST 85704 690-3681
CLINIC UNITED DRUGS #0016 1601 N. TUCSON BLVD. SPEEDWAY & TUCSON BLVD. CENTRAL 85717 326-4224
CVS PHARMACY #9207 865 E. GRANT ROAD 1ST & GRANT NORTH 85719 622-6475
CVS PHARMACY #9211 6484 N. ORACLE ROAD ORACLE & ORANGE GROVE NORTH 85704 297-8397
CVS PHARMACY #9232 4748 E SUNRISE DR SWAN & SUNRISE NORTHEAST 85718 299-9195
CVS PHARMACY #9272 7499 E. BROADWAY BLVD. BROADWAY & PRUDENCE EAST 85710 296-6222
CVS PHARMACY #9273 3785 W. INA ROAD INA & THORNYDALE NORTHWEST 85741 744-1054
CVS PHARMACY #9274 615 N ALVERNON 5TH & ALVERNON CENTRAL 85711 320-1184
40

CVS PHARMACY #9277 6895 E. SUNRISE DR KOLB & SUNRISE NORTHEAST 85718 615-4800
CVS PHARMACY #9302 8920 E TANQUE VERDE TANQUE VERDE & BEAR CANYON NORTHEAST 85749 760-9188
CVS PHARMACY #9336 7901 E GOLF LINKS RD GOLF LINKS & PANTANO EAST 85730 731-3098
CVS PHARMACY #9374 1900 W VALENCIA VALENCIA & HEADLEY SOUTHWEST 85746 807-2288
CVS/ECKERD PHARMACY #07841 4365 N. ORACLE RD. ORACLE & WETMORE NORTH 85705 407-2127
CVS/ECKERD PHARMACY #00091 8705 E SPEEDWAY BLVD. SPEEDWAY & CAMINO SECO EAST 85710 721-7631
CVS/ECKERD PHARMACY #08420 7740 N. CORTARO RD. CORTARO & SILVERBELL MARANA 85743 579-9918
CVS/ECKERD PHARMACY #07867 5100 E GRANT RD GRANT & ROSEMONT CENTRAL 85716 323-0012
CVS/ECKERD PHARMACY #07859 6370 N CAMPBELL AVE CAMPBELL & SKYLINE NORTH 85718 299-7390
CVS/ECKERD PHARMACY #07876 3832 E SPEEDWAY SPEEDWAY & ALVERNON CENTRAL 85716 323-3923
EL RIO PHARMACY * 839 W. CONGRESS CONGRESS & GRANDE WEST 85745 670-3725
EL RIO SOUTHEAST PHARMACY 6950 E GOLF LINKS RD GOLF LINKS & KOLB RD SOUTHEAST 85730 309-3250
EL RIO SOUTHWEST PHARMACY* 1510 W COMMERCE CT VALENCIA & MIDVALE SOUTHWEST 85746 806-2601
EL RIO WEST PHARMACY* 1701 W ST MARYS STE 150 ST. MARY'S & SILVERBELL WEST 85745 670-3839
EL RIO NORTHWEST PHARMACY* 330 W. PRINCE RD. PRINCE & ORACLE NORTH 85705 838-7699
FOOD CITY UNITED DRUG #156 1221 W IRVINGTON RD IRVINGTON & I-19 SOUTHWEST 85714 434-6921
FOOD CITY # 69 UNITED DRUGS 3923 N. FLOWING WELLS FLOWING WELLS & ROGER NORTH 85705 887-4422
K-MART PHARMACY #4996 7055 E. BROADWAY BROADWAY & KOLB EAST 85710 546-6535
OSCO DRUG #8960 7300 N LA CHOLLA BLVD INA & LA CHOLLA NORTHWEST 85741 575-0662
OSCO DRUG #8961 2854 N CAMPBELL AVE CAMPBELL & GLENN CENTRAL 85719 327-6767
OSCO DRUG #8964 9595 E BROADWAY BROADWAY & HARRISON EAST 85748 751-7549
OSCO DRUG #8972 1350 N SILVERBELL RD SPEEDWAY & SILVERBELL RD WEST 85745 623-9540
OSCO DRUG #8988 5085 N LA CANADA LA CANADA & RIVER NORTHWEST 85705 696-0340
OSCO DRUG #959 6363 E 22ND ST 22ND ST & WILMOT EAST 85710 571-9252
OSCO DRUG #963 6600 E GRANT RD GRANT & TANQUE VERDE EAST 85715 885-9192
SAFESCRIPT PHARMACY 310 N WILMOT RD STE 310 WILMOT & CARONDELET EAST 85711 298-8449
SAFEWAY FOOD & DRUG #0255-1 1551 W. ST MARY'S ROAD ST. MARY'S & SILVERBELL WEST 85745 624-8230
SAFEWAY FOOD & DRUG #267 2940 W. VALENCIA VALENCIA & CARDINAL WEST 85746 578-7246
SAFEWAY FOOD & DRUG #1255 7110 N. ORACLE ORACLE & INA NORTH 85704 575-1052
SAFEWAY FOOD & DRUG #1521 12122 N. RANCHO VISTOSO BLVD. 1ST & TANGERINE NORTH 85737 297-0260
SAFEWAY FOOD & DRUG #1684 1940 E BROADWAY BLVD BROADWAY & CAMPBELL CENTRAL 85719 206-9052
SAFEWAY FOOD & DRUG #1749 9100 N SILVERBELL RD SILVERBELL & TWIN PEAKS RD NORTHWEST 85743 579-8826
SAFEWAY FOOD & DRUG #1874 6360 E. GOLF LINKS WILMOT & GOLF LINKS EAST 85730 514-9567
SAFEWAY FOOD & DRUG #1983 2140 W. GRANT RD. GRANT & SILVERBELL WEST 85745 792-0334
SAFEWAY FOOD & DRUG #1986 9050 E. VALENCIA VALENCIA & NEXUS SOUTHEAST 85747 663-0700
SAFEWAY FOOD & DRUG #1988 7177 E. TANQUE VERDE TANQUE VERDE & SABINO CANYON NORTHEAST 85715 731-0147
41

SAFEWAY FOOD & DRUG #1989 9460 E. GOLF LINKS RD GOLF LINKS & HARRISION EAST 85730 296-4532
SAFEWAY FOOD & DRUG #2611 10380 E. BROADWAY BLVD. BROADWAY & HOUGHTON EAST 85748 546-3936
TARGET #0854 3901 W. INA RD. INA & THORNYDALE NORTHWEST 85741 918-3602
TARGET #0855 6500 E GRANT RD GRANT & TANQUE VERDE EAST 85715 917-0050
TARGET #700 10555 N. ORACLE ROAD ORACLE & 1ST AVE. ORO VALLEY 85737 520-219-4151
TARGET #1316 1255W. IRVINGTON RD I-19 & IRVINGTON RD. SOUTHWEST 85746 520-295-3608
TARGET #0179 5255 E BROADWAY BLVD BROADWAY & WILLIAMS BLVD CENTRAL 85711 917-0130
TARGET #1439 3699 E BROADWAY BLVD BROADWAY & DODGE CENTRAL 85716 917-0117
TARGET #1863 9615 E. OLD SPANISH TRAIL HARRISON & 22ND ST EAST 85748 296-3775
WALMART #1291 7150 E SPEEDWAY SPEEDWAY & KOLB EAST 85710 722-8669
WALMART #2922 7635 N LA CHOLLA BLVD LA CHOLLA & MAGEE NORTHWEST 85741 297-2418
WALMART #1325 455 E WETMORE WETMORE & 1ST NORTH 85705 887-7007
WALMART #1612 1650 W VALENCIA VALENCIA & MIDVALE SOUTHWEST 85746 573-3167
WALMART #3357 3925 E GRANT RD GRANT & ALVERNON CENTRAL 85712 327-9555
WALMART #10-4264 7951 N ORACLE RD ORACLE & MAGEE NORTHWEST 85704 469-9563
WALMART #10-4473 2175 W. RUTHRAUFF RD RUTHRAUFF & LA CHOLLA NORTHWEST 85705 292-2542
WALMART #10-4603 5500 E 22ND ST 22ND ST & CRAYCROFT EAST 85711 745-4527
WALMART #5031 8280 N CORTARO CORTARO & SILVERBELL MARANA 85743 744-6604
WALMART #103377 2823 W VALENCIA RD VALENCIA & MIDVALE SOUTHWEST 85746 908-2563
6369 E. TANQUE VERDE RD STE.
WILMOT CENTER UNITED DRUGS #0041 100 TANQUE VERDE & PIMA & WILMOT EAST 85715 721-3088
RURAL PHARMACIES
BASHA'S #34 UNITED DRUG 18785 S FRONTAGE RD I-19 & DUVAL MINE RD GREEN VALLEY 85614 520-648-3331
CVS PHARMACY #9254 240 W. CONTINENTAL GREEN VALLEY 85614 520-625-7286
CVS PHARMACY #8828 2090 E FRY BLVD SIERRA VISTA 85635 520-458-1254
FOOD CITY UNITED DRUG 450 GRAND COURT PLAZA NOGALES 85621 520-287-3984
FOOD CITY UNITED DRUG #112 1300 SAN ANTONIO AVE DOUGLAS 85607 520-364-3770
FRY'S PHARMACY #59 4351 E. HWY 90 HWY 90 & FRY BLVD. SIERRA VISTA 85635 520-458-0997
K-MART PHARMACY #3923 300 W. MARIPOSA NOGALES 85621 520-761-4117
MARIPOSA PHARMACY * 1852 N MASTICK WAY NOGALES 85621 520-377-5417

MARANA HEALTH CENTER PHARMACY * 13644 N SANDARIO RD MARANA 85653 520-682-1095
MEDICINE SHOPPE 795 W 4TH ST BENSON 85602 520-586-1299
OLD PUEBLO UNITED DRUGS 3272 HWY 82 HWY 82 & HWY 83 SONOITA 85637 520-455-0058
42

OSCO DRUG #968 1116 E. FLORENCE BLVD. CASA GRANDE 85222 520-421-9920
RIO RICO PHARMACY 1103 CIRCULO MERCADO STE A RIO RICO 85648 520-761-3338
SAFEWAY FOOD & DRUG #1275 599 W 4TH ST 4TH & OCOTILLO BENSON 85602 520-586-7323
SAFEWAY FOOD & DRUG #2044 260 W. CONTINENTAL GREEN VALLEY 85614 520-625-1941
SAFEWAY FOOD & DRUG #1771 1301 W DUVAL MINE RD DUVAL MINE RD. & LA CANADA SAHUARITA 85629 520-393-0084
TOMBSTONE PHARMACY 512 ALLEN ST TOMBSTONE 85638 520-4573543
TOM'S PHARMACY 40 PLAZA PLAZA & HWY. 85 AJO 85321 520-387-7080
WALMART #1324 100 W. WHITE PARK DRIVE NOGALES 85621 520-281-2594
WALMART #1411 18705 S. FRONTAGE BLVD. FRONTABLE BLVD. & ABREGO DR. GREEN VALLEY 85614 625-3824
WALGREENS #7623 409 W. MARIPOSA RD MARIPOSA & GRAND NOGALES 85621 281-4398
** SOME PHARMACY PROVIDERS DO DELIVER; HOWEVER, PHS MUST AUTHORIZE THE DELIVERY PRIOR TO THE SERVICE BEING
OBTAINED
* only for members assigned to their network
INSTITUTIONAL PHARMACIES
ACCREDO HEALTH GROUP 9494 N 25TH AVE PHOENIX 85021 602-944-1199

AZ SENIOR CARE 55 W HOOVER AVE STE 10 MESA 85210 888-770-7766
DAVITA RX 1234 LAKESHORE DR. STE. 200 COPPELL 75019 972-538-8100
GOOTS NURSING HOME PHARMERICA 1728 W GLKENDALE AVE PHOENIX 85021 602-995-1320
MEDICAL ARTS PHARMACY 1946 S DOBSON RD. STE. 3 MESA 85202 480-345-2555
OMNICARE PHOENIX 3902 E UNIVERSITY STE D1 PHOENIX 85034 602-437-5420
ONE POINT PATIENT CARE 3001 S PRIEST DR TEMPE 85282 480-240-1122
PHARMERICA 3700 E COLUMBIA ST., STE 100 TUCSON 85714 520-745-0025
SALIBAS 11713 W THUNDERBIRD EL MIRAGE 85335 623-815-8965
SAFETY DRUGS 20612 N CAVE CREEK RD STE 150 PHOENIX 85024 602-252-1299
SPECTRUM PHARMACY OF AZ 6150 E GRANT RD GRANT & WILMOT TUCSON 85712 520-296-0317
HOME INFUSION PHARMACIES

CRITICAL CARE SYSTEMS MEMBER HOMES TUCSON 888-897-9395
FOX INFUSION MEMBER HOMES TUCSON 520-795-0111
END OF ATTACHMENT K
43
ATTACHMENT L
UTILIZATION AND AUTHORIZATIONS
Below lists the number of transactions from October 2008 – September 2009 through the existing system along with the
authorization counts. No guarantee is made that this will be the same configuration of services required in subsequent
years.
MONTHLY UTILIZATION (Number of paid prescriptions)
Quarter Year Number Of Prescription Claims

October - December 2008 29,452
January - March 2009 30,931
April - June 2009 31,415
July - September 2009 32,445
MONTHLY AUTHORIZATIONS
MONTH YEAR NUMBER OF TOTAL NUMBER OF

AUTHORIZATIONS AUTHORIZATIONS
REVIEWED BY PBM PER ENTERED PER MONTH
MONTH
October 2008 22 103
November 2008 15 61
December 2008 32 80
January 2009 48 65
February 2009 44 73
March 2009 32 58
April 2009 24 65
May 2009 28 60
June 2009 53 28
July 2009 25 68
August 2009 22 40
September 2009 22 44
END OF ATTACHMENT L
44
EXHIBIT A
MINIMUM QUALIFICATIONS VERIFICATION FORM
COMPANY NAME:
Offeror certifies that they possess the following minimum qualification and shall provide the requested documents that
substantiate their satisfaction of the Minimum Qualifications. Failure to provide the information required by these Minimum
Qualifications and required to substantiate responsibility may be cause for the offeror’s proposal to be rejected as Non-
Responsive.
Provide documented and verifiable evidence that your firm satisfies the following Minimum Qualifications, and indicate
what/if attachments are submitted.
COMPLIANCE
YES/NO DOCUMENT TITLE AND
ITEM (SELECT ONE) NUMBER OF PAGES
MINIMUM QUALIFICATIONS
NO. A No answer shall be cause SUBMITTED FOR EACH
of your offer deemed Non- DOCUMENT
Responsive
YES, attach a copy of current
business license.
1 Offeror must have a valid business license.
NO
YES, attach a copy of current

Offeror’s pharmacist who provides pharmacy State of Arizona pharmacist
consultant services must hold a valid pharmacist license.
2
license issued by the Arizona State Board of
Pharmacy. NO
YES, Please provide

pharmacy’s AHCCCS
Provider Number in response
to Exhibit C Question #22. If a
pharmacy does not currently
has a AHCCCS provider
Pharmacies in Offeror’s network must have an number, a copy of the
3 active AHCCCS Provider Number at the time pharmacy’s AHCCCS
services are provided. Provider Registration
Application Form must be
provided.
NO
SIGNATURE: DATE:
PRINTED NAME & TITLE OF AUTHORIZED OFFEROR REPRESENTATIVE EXECUTING OFFER
45
EXHIBIT B
PROPOAL PRICING SHEET
COMPANY NAME:
1. Paid Claims Transaction Fee (0 to 10 points)
Pharmacy processing of electronically submitted prescription claims is paid at a rate of $ per paid
prescription claim transaction. This amount must include, if any, cost of the switching fee for transmission. The
pharmacy may not be billed any additional fees for electronically submitting online prescription claims. There will not be
a transaction fee for rejected claims.
PBM must bill PHS with the detailed number of transactions by member group and total. There will not be any additional
reimbursement for a mandatory generic substitution program.
Offeror must include cost of providing pharmacist consultative services (as outlined in the Scope of Services) into the
prescription paid transaction rate proposed above.
2. Average Wholesale Price (AWP) minus percent discount for Brand Name Drugs (0 to 20 points)
Reimbursement for Brand Name prescription products is the Average Wholesale Price (AWP) minus % or
the usual and customary (U&C) charge, whichever is less, plus the lesser of a contracted filling fee of One Dollar and
Fifty Cents ($1.50) or submitted filling fee.
3. Average Wholesale Price (AWP) minus percent discount for Generic Drugs (0 to 10 points)
Reimbursement for Generic Drug is the PLAN’s MAC price or AWP minus % or the usual and customary
(U&C) charge, whichever is less, plus the lesser of a contracted filling fee of One Dollar and Fifty Cents ($1.50) or
submitted filling fee.
4. Maximum Allowable Charges (MAC) Pricing (0 to 10 points)
Complete Exhibit B-1 Maximum Allowable Charges (MAC) Pricing Sheet and enter the Total MAC Price Proposed
here $
With your proposal, provide Exhibit B-1 an Excel Spreadsheet on a CD-ROM. One original and one copy are
required.
5. Reimbursement for delivery of pharmaceuticals and/or supplies per site/per member authorized by PLAN is Six
Dollars ($6.00).
((Note: Long Term Care pharmacies are required to deliver medications to LTC members’ facilities at no charge).
6. Reimbursement for bubble packaging, per card, per PLAN authorized member is Fifty Cents ($.50).
Note: Should Average Sales Price (ASP) or Average Manufacturer Price (AMP) methodology be implemented by CMS,
PLAN reserves the right to renegotiate price based on ASP or AMP through a duly executed agreement.
The Offeror MUST complete the BLANKS on the Proposal Pricing Sheet.
SIGNATURE: DATE:
46
Exhibit B-1
MAXIMUM ALLOWABLE CHARGES (MAC) PRICING SHEET
COMPANY NAME:
Estimated
Line Annual Proposed MAC Extended MAC
MAC Name
No. Usage Unit Price$ Amount$
(Metric Qty)
1 ALBUTEROL NEB 0.083% 93,128 $ $
2 ALBUTEROL NEB 0.5% 2,882 $ $
3 ALENDRONATE TAB 10MG 312 $ $
4 ALENDRONATE TAB 35MG 12 $ $
5 ALENDRONATE TAB 70MG 1,070 $ $
6 ALPRAZOLAM TAB 0.25MG 36,731 $ $
7 ALPRAZOLAM TAB 0.5MG 31,815 $ $
8 ALPRAZOLAM TAB 1MG 23,070 $ $
9 ALPRAZOLAM TAB 2MG 5,310 $ $
10 BACLOFEN TAB 10MG 58,432 $ $
11 BACLOFEN TAB 20MG 33,863 $ $
12 BUDESONIDE SUS 0.5MG/2 4,167 $ $
13 BUPROPION TAB 100MG 5,358 $ $
14 BUPROPION TAB 100MG SR 1,797 $ $
15 BUPROPION TAB 150MG SR 3,990 $ $
16 BUPROPION TAB 200MG SR 810 $ $
17 BUPROPION TAB 75MG 8,744 $ $
18 CITALOPRAM TAB 10MG 4,389 $ $
21 CLONAZEPAM TAB 0.5MG 60,847 $ $
22 CLONAZEPAM TAB 1MG 39,999 $ $
23 CLONAZEPAM TAB 2MG 15,518 $ $
24 CLOZAPINE TAB 100MG 3,216 $ $
25 CLOZAPINE TAB 25MG 465 $ $
26 DIAZEPAM TAB 10MG 42,371 $ $
47
29 DIVALPROEX CAP 125MG 30,138 $ $

DIVALPROEX TAB 125MG DR /
30 990 $ $
EC
31 10,460 $ $
EC
32 DIVALPROEX TAB 250MG ER 1,589 $ $
33 9,986 $ $
EC
34 DIVALPROEX TAB 500MG ER 24,863 $ $
35 DOCUSATE SOD CAP 100MG 295,689 $ $
36 FENTANYL DIS 100MCG/H 480 $ $
37 FENTANYL DIS 25MCG/HR 498 $ $
40 FEXOFENADINE TAB 30MG 630 $ $
41 FEXOFENADINE TAB 60MG 7,605 $ $
42 GABAPENTIN CAP 100MG 15,444 $ $
45 GABAPENTIN TAB 600MG 24,054 $ $
46 GABAPENTIN TAB 800MG 4,395 $ $
47 HEPARIN SOD INJ 5000/ML 5,189 $ $
48 HYDROCO/APAP TAB 10-325MG 1,800 $ $
51 HYDROCO/APAP TAB 7.5-500 3,120 $ $
52 HYDROCODONE/ SOL APAP 22,991 $ $
53 HYDROMORPHON TAB 2MG 5,859 $ $
56 IPRATROPIUM SOL INHAL 40,493 $ $
57 LAMOTRIGINE TAB 100MG 812 $ $
58 LAMOTRIGINE TAB 150MG 1,535 $ $
48
59 LAMOTRIGINE TAB 200MG 3,111 $ $
60 LAMOTRIGINE TAB 25MG 153 $ $
61 LEVETIRACETA SOL 100MG/ML 21,096 $ $
62 LEVETIRACETA TAB 1000MG 1,215 $ $
63 LEVETIRACETA TAB 250MG 315 $ $
66 LEVOTHYROXIN TAB 100MCG 7,920 $ $
69 LEVOTHYROXIN TAB 137MCG 585 $ $
71 LEVOTHYROXIN TAB 175MCG 900 $ $
77 LISINOPRIL TAB 10MG 14,012 $ $
78 LISINOPRIL TAB 2.5MG 4,275 $ $
80 LISINOPRIL TAB 30MG 783 $ $
83 LORAZEPAM INJ 2MG/ML 1,203 $ $
84 LORAZEPAM INJ 4MG/ML 17 $ $
85 LORAZEPAM TAB 0.5MG 169,968 $ $
86 LORAZEPAM TAB 1MG 114,463 $ $
87 LORAZEPAM TAB 2MG 31,028 $ $
88 METFORMIN TAB 1000MG 18,891 $ $

49
91 METOCLOPRAM SOL 5MG/5ML 29,997 $ $
92 METOCLOPRAM TAB 10MG 22,889 $ $
93 METOCLOPRAM TAB 5MG 14,477 $ $
94 MORPHINE SUL SOL 10MG/5ML 29,880 $ $
95 MORPHINE SUL SOL 20MG/ML 1,380 $ $

MORPHINE SUL TAB 100MG CR /
96 4,128 $ $
ER
97 MORPHINE SUL TAB 15MG 9,744 $ $
98 23,192 $ $
ER
99 MORPHINE SUL TAB 30MG 5,906 $ $
100 18,714 $ $
ER
101 18,654 $ $
ER
102 OXYCOD/APAP TAB 5-325MG 104,753 $ $
103 OXYCODONE CAP 5MG 7,365 $ $
104 OXYCODONE TAB 15MG 5,198 $ $
107 PHENYTOIN SUS 125/5ML 12,443 $ $
108 PHENYTOIN EX CAP 100MG 28,679 $ $
109 PRENATAL 26,379 $ $
110 PRENATAL TAB PLUS 57,696 $ $
111 RANITIDINE SYP 15MG/ML 6,459 $ $
112 RANITIDINE SYP 75MG/5ML 5,772 $ $
113 RANITIDINE TAB 150MG 38,534 $ $
114 RANITIDINE TAB 300MG 3,498 $ $
115 RISPERIDONE TAB 0.25MG 398 $ $
116 RISPERIDONE TAB 0.5MG 1,568 $ $
117 RISPERIDONE TAB 1MG 4,529 $ $
121 SPIRONOLACT TAB 100MG 4,287 $ $
50
124 TEMAZEPAM CAP 15MG 40,260 $ $
125 TEMAZEPAM CAP 30MG 28,412 $ $
126 TOPIRAMATE TAB 100MG 1,730 $ $
127 TOPIRAMATE TAB 200MG 690 $ $
128 TOPIRAMATE TAB 25MG 1,263 $ $
129 TOPIRAMATE TAB 50MG 757 $ $
130 WARFARIN TAB 10MG 560 $ $
131 WARFARIN TAB 1MG 2,442 $ $
132 WARFARIN TAB 2.5MG 735 $ $
138 WARFARIN TAB 7.5MG 995 $ $

FOB Destination/Unloaded; Cost Total MAC Price
of freight should be included in Proposed
Unit Price.
Do Not include sales tax in Unit

Price.
SIGNATURE: DATE:
51
EXHIBIT C
COMPANY CAPABILITY QUESTIONNAIRE SHEET
COMPANY NAME:
Proposer must submit documentation and methodology to support its ability to comply with the following:
1. Collect, store, edit and/or transmit all data describe in Appendix IV, Appendix V and Appendix VI If transaction
formats must vary, attach your formats and clearly discuss the costs associated with varying and/or customizing
your field formats to meet our requirements.
2. Meet on-line Pharmacy Benefit Manager requirements as outlined in Appendix III.
3. Allow PLAN users to manually add a newly eligible member in real time.
4. Accept daily electronic transmission for member files and load (update) the files within 24 hours. If you are
unable to load files within 24 hours, please state your loading day(s) and time(s) requirements. Membership
number will be a 9 digit alpha-numeric field (this field cannot be varied). Contractor must be able to accept as
little as one (1) day of eligibility or one (1) day of ineligibility and to maintain an eligibility history on each member.
5. Maintain a drug file including over-the-counter pharmaceuticals. Can these over-the-counter items be included on
a positive formulary and processed like a prescription pharmaceutical? If your drug file does not contain a
specific over-the-counter item, can this item be added to the list? How long would it take to add over-the-counter
items to the drug file? PLEASE NOTE: PLAN currently authorizes payment for approximately 200 different over-
the-counter pharmaceuticals.
6. Allow a minimum of two (2) plan users access to the on-line information (specific requirements are listed in II
Scope #A9). The access and software application must be technically and financially supported by the
Contractor. Pricing for this access will be included in the per script charges displayed in the pricing page.
(Hardware support will be provided by PHS). Access can be granted through an internet account established by
the Contractor. PHS will not incur any internet or telephonic expenses associated with this access. Plan users
should be able to connect to the on-line information from any hardware site with internet connection; however
Contractor will only be financially responsible for three (3) connections.
7. Accept a positive formulary. Can you support more than one formulary for PHS?
8. Cable of receiving on-line transmissions from pharmacies and edit for the following:
a) Member on file with current eligibility.

b) Determine member benefit group and formulary.
c) Medical provider positive/negative participation.
d) Prescription meets the requirements listed in APPENDIX VI.
9. Price drugs according to the lesser of either AWP (+ or - x%), PLAN MAC pricing, or usual and customary
charges, plus contract filling fee. Please include a hard copy and an electronic copy of the MAC pricing table
you would use for this contract and information regarding how that table is maintained and updated. Can over-
the-counter items be added to the MAC pricing table?
10. Provide for a minimum of 8 separate sub-populations (groups) within the PLAN’s membership? Can each group
have a separate benefit plan, formulary, medical and pharmacy provider list, and edits as detailed in Appendix III?
11. Allow specified pharmacy providers to have different reimbursement rates.
12. How many days does your organization allow for a contracted pharmacy provider from the date of fill to submit
claims or make adjustments (e.g. reversal of a claim)? How many days from the date of fill would the PLAN have
to make a manual adjustment (e.g. reversal of a claim)?
13. Describe how you back-up data in case of an emergency and how long you store the data after it has been
transmitted to the PLAN.
52
EXHIBIT C
COMPANY CAPABILITY QUESTIONNAIRE SHEET (Continued)
14. State the phone number and hours of your help desk. Also state the averages for: 1) wait time, 2) resolution of
the concern, 3) abandonment rate for calls. Describe your Help Desk’s ability to cover PLAN calls during PLAN
employee sick call or vacation. Provide your written policies and procedures for Help Desk coverage.
15. Describe your performance measures for help desk customer satisfaction. How are these standards monitored
for assurance with performance measures?
16. Please indicate from which switch companies you can accept electronic claims.
17. Provide evidence that your company is able to provide AHCCCS required reports as required by PLAN
electronically and that electronic data can be manipulated to develop specific user defined reports. The following
reports are required for this contract. At the minimum reports *b) through *h) must be available in an Excel or CSV
format:
a) Drug Cost Ranking Summaries – Monthly and Quarterly
b) *Member Prior Authorization Detail – Monthly and Quarterly
c) *Members with 50 or More Claims – Monthly and Quarterly
d) *Members with 70 or more Claims Long Term Care - Quarterly
e) *Members with 9 or More Controlled Drug Rx - Quarterly
f) *Members with More Than 1500 Dollars in Claims - Quarterly
g) *Members with More Than 3000 Dollars in Claims Long Term Care – Quarterly
h) *Rejected Prescription Claim Detail Report – Weekly & Monthly
i) Pharmacy Provider Performance Summaries
j) Prescriber Utilization Summary By Cost - Quarterly
k) Prior Authorization Summary - monthly and Quarterly
l) Therapeutic Class Detail – Monthly and Quarterly
m) Therapeutic Class Usage Summaries – Monthly and Quarterly
n) AHCCCS Mandated Data Reports –generally ad hoc
o) Copy of PLAN MAC list - Quarterly
18. Are you or have you ever been excluded from participation in Federal Health Care Programs, including Medicare
or Medicaid?
If Yes, when
19. Describe your procedure for initiating a contract with a pharmacy provider at the request of the PLAN (e.g., a
PLAN contracted pharmacy not currently part of your network).
20. Provide samples of DUR, over/under utilization, provider profiling, compliance reporting offered.
21. Provide curriculum vitae of licensed pharmacist(s) who will be available to provide consulting pharmacist services
as defined in this solicitation.
22. Please provide a listing of your contracted pharmacies, both retail and long term care, in Pima and Santa Cruz
Counties. The listing should include name, address, ACCCHS provider number, National Provider Identifier (NPI)
number, whether retail or LTC, ability to make deliveries and/or offer bubble packaging, and any other relevant
data. Also include a listing of pharmacies, both retail and LTC, in Maricopa County as Pima Health System may
have between 10-15 members placed in Maricopa County LTC facilities at any one time.
23. Please describe the implementation plan you would utilize if awarded this contract.
24. Ability to perform Medicare billing, including Medicare Part B. Ability to perform split billing for primary and
secondary insurance payments and co-payment amounts.
END OF EXHIBIT C
53
EXHIBIT D
FINANCIAL QUESTIONNAIRE SHEET
COMPANY NAME:
1. Please submit your latest Audited Financial Statements (if an audited financial statement is not available, you
may submit a compiled financial statement reviewed and signed by an outside certified public accountant.)
Audited Financial Statements is provided in a separate envelop.
Compiled financial statement reviewed and signed by an outside certified public accountant is provided in a
separate envelop.
2. Has your organization or any subsidiary ever gone through or are currently in the process of bankruptcy? Are
there any lawsuits, judgments, tax deficiencies or claims pending or adjudicated against your organization? Has
your organization terminated any contracts, had any contracts terminated or been involved in any contract
lawsuits?
Yes No
(If yes, please describe):
3. Will your organization have sufficient funds to cover its costs fully and on time under the contract while awaiting
reimbursement from the County?
Yes No
SIGNATURE: DATE:
54
EXHIBIT E
REFERENCE SHEET
COMPANY NAME:
Please list 3 references with whom you have provided prescription benefit manager and pharmacy services. The
reference must be within the past five (5) years in the United States. References must demonstrate provision of services
for a minimum of two (2) years.
REFERENCE #1:
Company Name:
Contact Name: Title:
Address:
Phone Number: Fax Number:
Services were provided from to
Description of services performed.
REFERENCE #2:
Company Name:
Address:
Description of services performed:
REFERENCE #3:
Company Name:
Address:
Description of services performed:
SIGNATURE: DATE:
55
EXHIBIT F
SUSTAINABILITY QUESTIONNAIRE
COMPANY NAME:
Pima County desires to contract with Companies that incorporate Sustainable practices in their own operations:
1. Does your Company promote a philosophy and/or maintain policies on waste prevention, reduction, recycling
and/or reuse of your Company’s material resources? (Circle one): Yes No
2. Does your Company utilize environmentally preferable materials in your operations, including purchase of locally
produced/manufactured products to minimize transport(Circle one): Yes No
3. Does your Company utilize alternative energy such as solar or wind energy, and use of bio-diesel or other
alternative fuels in support of your Company’s energy needs. (Circle one): Yes No
4. Does your Company’s internal office practices lessen the impact on non-renewable resources and global climate
change (reduction in water, energy, or paper use, minimization of hazardous materials use, compressed or
flexible work week schedules, etc.) (Circle one): Yes No
Answers to the above questions have no bearing on evaluation and award of contract.
SIGNATURE: DATE:
56
EXHIBIT G
CERTIFICATION FORM
OFFEROR LEGAL NAME:
BUSINESS ALSO KNOWN AS:
MAILING ADDRESS:
CITY/STATE/ZIP:
REMIT TO ADDRESS:
CITY/STATE/ZIP:
CONTACT PERSON NAME/TITLE:
PHONE: FAX:
CONTACT EMAIL ADDRESS:
E-MAIL ADDRESS TO WHICH ORDERS CAN BE TRANSMITTED:
CORPORATE HEADQUARTERS LOCATION:
ADDRESS:
CITY, STATE, ZIP:
Offeror acknowledges that the following solicitation addenda have been incorporated in their offer:
Addendum # Date Addendum # Date Addendum # Date
By signing and submitting this Certification Form, the undersigned certifies that they are legally authorized to represent
and bind the “Offeror” to legal agreements, that all information submitted is accurate and complete, that the firm has
reviewed the Procurement website for solicitation addenda and incorporated to their offer, that the firm is qualified and
willing to provide the items requested, and that the firm will comply with all requirements of the solicitation. The
undersigned hereby offers to furnish the material or service in compliance with all terms, conditions, specifications,
defined or referenced by the solicitation, which includes but may not be limited to the Instruction to Offerors, Pima County
Standard Terms & Conditions, Special Terms and Conditions, and Sample Agreement. The Unit Pricing includes all
costs incidental to the provision of the items in compliance with the above documents; no additional payment will be
made. Conditional offers that modify the solicitation requirements may be deemed not ‘responsive’ and may not be
evaluated.
SIGNATURE: DATE:
MAILING ADDRESS
PHONE AND E-MAIL:
57
EXHIBIT H
AGREEMENT
PIMA COUNTY ON BEHALF OF
PIMA HEALTH SYSTEM
WITH
PHARMACY BENEFIT
MANAGER
TABLE OF CONTENTS
Article Page
I. Definitions............................................................................................................................................ 1-2
II. General Provisions
II.1 Term And Termination ................................................................................................................ 3

A. Term ...................................................................................................................................... 3
B. Termination Without Cause.................................................................................................. 3
C. Termination For Cause ......................................................................................................... 3
D. Insolvency ............................................................................................................................. 3
II.2 Contract Extensions...................................................................................................................... 3
II.3 AHCCCS Subcontract Provisions ............................................................................................... 3
II.4 Total Payment............................................................................................................................... 3
II.5 Non-Warranty............................................................................................................................... 3
II.6 Books Records And Rights To Audit .......................................................................................... 3
II.7 Licensure And Registration....................................................................................................... 3-4
II.8 Compliance With All Laws.......................................................................................................... 4
II.9 Severability................................................................................................................................... 4
II.10 Non-Discrimination...................................................................................................................... 4
II.11 Americans With Disabilities Act ................................................................................................. 4
II.12 Insurance....................................................................................................................................... 4
A. Professional Liability ............................................................................................................ 4
B. Commercial General Liability .............................................................................................. 4
C. Automobile Liability............................................................................................................. 4
D. Worker’s Compensation ....................................................................................................... 4
II.13 Confidentiality.............................................................................................................................. 4
II.14 Indemnification............................................................................................................................. 5
II.15 Non-Appropriation ....................................................................................................................... 5
II.16 Remedies ...................................................................................................................................... 5
II.17 Non-Assignment........................................................................................................................... 5
II.18 Non-Waiver .................................................................................................................................. 5
II.19 Conflict of Interest........................................................................................................................ 5
II.20 Independent Contractors .............................................................................................................. 5
II.21 Health Insurance Portability and Accountability Act (HIPAA).................................................. 5
II.22 Other Documents.......................................................................................................................... 5
II.23 Srutinized Business Operations ................................................................................................... 5
II.24 Notices .......................................................................................................................................... 6
III. Plan Provisions
III.1 Services......................................................................................................................................... 7
III.2 Compensation............................................................................................................................... 7
III.3 Payment Method........................................................................................................................... 7
A. Claim Submission for Paid Claims Transaction Fee ........................................................... 7
B. Encounter and Claim Submissions for Pharmacy Claims ................................................... 7
C. Third Party Liabilities ........................................................................................................... 7
D. Denials................................................................................................................................... 7
E. Payment Recoupment ........................................................................................................... 7
F. False Claims Act ................................................................................................................... 7
III.4 Sanctions....................................................................................................................................... 8
A. Penalties ................................................................................................................................ 8
B. Liquidated Damages to PLAN ............................................................................................. 8
IV. Entire Agreement .................................................................................................................................. 9
i
TABLE OF CONTENTS
Continued
Article Page
A. AHCCCS and ALTCS Minimum Subcontract Provisions ....................................................... 10-13

B. Pharmacy Benefit Manager Scope of Services ........................................................................... 14-15
B.1 Pharmacy Consultant Scope of Services ..................................................................................... 16-17
B.2 Pharmacy Network Scope of Services............................................................................................... 18
C. Pricing Sheet ........................................................................................................................................ 19
D. Business Associate Agreement ...................................................................................................... 20-22
ii
This Agreement is entered into by and between Pima County, a body politic and corporate of the State of Arizona, herein called
"COUNTY", on behalf of Pima Health System, herein called "PLAN” and , hereinafter called "COMPANY".
RECITALS
WHEREAS, COUNTY provides Pharmacy Benefit Manager and Pharmacy services through Pima Health System ("PLAN")
pursuant to a contract with the Arizona Health Care Cost Containment System (AHCCCS), and Arizona Long Term Care
System (ALTCS), and Pima County,
WHEREAS, COMPANY submitted the most advantageous response to County for RFP # 1001249 for Pharmacy Benefit
Manager and Pharmacy services;
NOW THEREFORE, in consideration of the mutual covenants and agreements contained herein, the Parties hereto agree as
follows:
ARTICLE I
DEFINITIONS
I.1. Unless the context clearly requires a contrary meaning, the following terms shall have the definitions indicated:
A. Agreement/Contract: Entire document, any document incorporated herein by reference and all present and future attachments
and amendments.
B. AHCCCS: Arizona Health Care Cost Containment System as defined by A.R.S. Title 36 Chapter 29. AHCCCS is composed of
the Administration, its contracted health plans and program contractors, and other arrangements through which health care
services are provided to eligible and enrolled Members.
C. AHCCCSA: Administrative services for the Arizona Health Care Cost Containment System as defined by A.R.S. Title 36.
D. ALTCS: Arizona Long Term Care System as authorized by A.R.S. § 36-2931.
E Capitation Payment: A prospective, predetermined payment per Member per month for services.
F. Clean Claim: Claim that may be processed without obtaining additional information from the subcontracted provider of
care, from a non-contracting provider or from a third party but does not include claims under investigation for fraud or abuse
or claims under review for medical necessity. (A.R.S. §36-2904 (G)(1))
G. Covered Services: Medically necessary health services Members are entitled to receive as set forth in the Arizona
Administrative Code R9-22-202, et seq. and as adopted by Pima County.
H. Member: An individual who is eligible for AHCCCS, ALTCS or Medicare Advantage and enrolled with the PLAN, or an
individual determined by PLAN to be County eligible and who is not otherwise covered by a separate agreement between
COMPANY and COUNTY or between COUNTY and AHCCCS.
I. PLAN Standards and Procedures: All written rules, policies and procedures of the PLAN regarding matters in connection
with the delivery of medical services, including, but not limited to procedures on the following: authorization, referral and
utilization, credentialing, billing and payment, coordination of benefits, Member grievance, and UM/QM provisions.
J. Quality Management (QM): The methodology used by the PLAN to monitor and assess conformity with AHCCCS, ALTCS,
PLAN medical standards and practices; and activities designed to improve and maintain quality care provided to Members
through implementation of a formal program with involvement of multiple organizational components.
K. Referral: The process whereby a Member’s Primary Care Provider directs a Member to another appropriate provider or
resource for diagnosis and/or treatment.
L. Third Party: Any individual, entity or program that is or may be liable to pay all or part of the medical cost of injury, disease
or disability.
1
M. Utilization Management (UM): The methodology used by PLAN to monitor and assess the appropriateness and efficiency of
care provided to Members; and activities designed to improve the utilization of care provided to Members through
implementation of a formal program with involvement of multiple organizational components.
THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK
Ver 12/09 2
ARTICLE II
GENERAL PROVISIONS
II.1 - TERM AND TERMINATION

A. Term: The term of this Agreement shall be from June 1, 2010 to May 31, 2011 unless sooner terminated or further extended
pursuant to the provisions of this Agreement.
B. Termination Without Cause: After the end of the first year either party may terminate this Agreement without cause by
giving ninety (90) days prior written notice to the other party. The first year of the contract will end on midnight May 31,
2011. In the event of such termination, COUNTY’s only obligation to COMPANY shall be for payment for Covered
Services rendered prior to termination.
C. Termination for Cause: COUNTY may terminate this Agreement at any time, without advance notice and without further
obligation on the part of the COUNTY, if the COUNTY determines that the COMPANY is in default of any provision of this
Agreement or PLAN has reason to believe that continuation of the Agreement may pose a health or safety risk to its
Member(s).
D. Insolvency: The COUNTY may terminate this Agreement immediately by providing written notice to the COMPANY by
the PLAN Administrator or designee for any of the following:
1. In the event of the filing by or against the COMPANY in a court of competent jurisdiction of a petition for bankruptcy,
reorganization, dissolution, liquidation, conservatorship, supervision or receivership, where COUNTY determines such
filing will adversely impact the care or financial well-being of the Member;
2. Upon the inability of the COMPANY to pay its debts as they mature;
3. Upon an assignment of assets by the COMPANY for the benefit of its creditors.
II.2 - CONTRACT EXTENSIONS

This Agreement shall not be construed as being subject to automatic renewal. This Agreement may be extended for up to four (4)
additional one (1) year periods through a duly-executed amendment signed by both COMPANY and COUNTY.
II.3 - AHCCCS SUBCONTRACT PROVISIONS

COMPANY agrees to comply with all AHCCCS Subcontract Provisions contained in Attachment A as updated by AHCCCSA.
II.4 - TOTAL PAYMENT

Total payment for the term of this Agreement shall not exceed $ unless a duly executed amendment has been issued and signed
by COMPANY and COUNTY.
II.5 - NON-WARRANTY
The parties do not warrant their respective right or power to enter into this Agreement and if the same is declared null and void by court
action initiated by third persons, there shall be no liability to the other party by reason of such action or by reason of this Agreement.
II.6 - BOOKS RECORDS AND RIGHTS TO AUDIT

COMPANY shall keep and maintain proper and complete books, records, accounts, and documents, both medical and non-medical, as
may be required by applicable state and federal laws, rules and regulations. The COMPANY shall cooperate with the COUNTY and
ensure that all books, records, accounts and documents relating to Members shall be open, upon reasonable notice, for inspection and
audit by authorized representatives of the COUNTY, AHCCCS, and HCFA at all reasonable times.
COMPANY must maintain an adequate Cost Record Keeping System such that services to each Member and cost thereof can be readily
identified.
II.7 - LICENSURE AND REGISTRATION

COMPANY shall apply for, obtain and maintain any State of Arizona license, registration or permit necessary to conduct business or
render service pursuant to and during the entire term of this Agreement. Notification of granting or denial of the permit or license shall
immediately be sent to COUNTY who notwithstanding the provisions of II.1, may immediately terminate the Agreement without
obligation for any services provided after such termination. COMPANY must be registered as an AHCCCS provider.
Ver 12/09 3
COMPANY shall notify the PLAN within ten (10) days of the commencement of any legal or administrative proceedings that may result
in revision, revocation, censure, dismissal, suspension or limitation of required licenses to provide contracted service or other provider
privileges. COMPANY shall immediately notify the PLAN of all revisions, revocations, censures, dismissals, suspensions or limitations
of required licenses or COMPANY privileges.
II.8 - COMPLIANCE WITH ALL LAWS

COMPANY shall comply with all federal, state and local laws, rules, regulations, standards and Executive Orders, without limitation to
those designated within this Agreement. The laws and regulations of the State of Arizona shall govern the rights of the parties, the
performance of this Agreement and any disputes hereunder. Any action relating to this Agreement shall be brought in a court of the State
of Arizona in Pima County. Any changes in the governing laws, rules and regulations during the terms of this Agreement shall apply but
do not require an amendment.
II.9 - SEVERABILITY
If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall continue valid and enforceable to the
full extent permitted by law.
II.10 - NON-DISCRIMINATION
COMPANY shall not discriminate against any COUNTY employee, client or any other individual in any way because of that person’s
age, race, creed, color, religion, sex, disability or national origin in the course of carrying out the COMPANY’S duties pursuant to this
Agreement. COMPANY shall comply with the provisions of Executive Order 75-5, as amended by Executive Order 99-4, which is
incorporated into this Agreement by reference, as if set forth in full herein.
COMPANY shall not discriminate or differentiate against any Member because of that persons payer source, race, color, creed, sex,
religion, age, national origin, ancestry, marital status, sexual preference, or physical or mental handicap, except where medically
indicated.
II.11- AMERICANS WITH DISABILITIES ACT

COMPANY shall comply with all applicable provisions of the Americans with Disabilities Act (Public Law 101-336, 42 U.S.C. 12101-
12213) and all applicable federal regulations under the Act, including 28 CFR Parts 35 and 36.
II.12 - INSURANCE
COMPANY shall provide evidence of insurance as follows:
A. Professional Liability: COMPANY shall maintain professional liability insurance with a minimum of $1,000,000 per
incident, $3,000,000 aggregate, per year.
B. Commercial General Liability: COMPANY shall maintain commercial general liability in the amounts of $1,000,000
combined, single limit Bodily Injury and Property Damage or $1,000,000 Bodily Injury, $1,000,000 Property Damage.
COUNTY is to be named as an additional insured for all operations performed within the scope of the contract between
COUNTY and COMPANY.
C. Automobile Liability: If applicable COMPANY shall procure and maintain automobile liability coverage for owned, non-
owned and hired vehicles .with limits in the amount of $1,000,000 combined single limit or $1,000,000 Bodily Injury,
$1,000,000 Property Damage.
D. Worker's Compensation: Evidence of statutory Worker's Compensation coverage must also be provided.
COUNTY is to be named as an additional insured for all operations performed within the scope of the contract between COUNTY
and COMPANY. COMPANY shall provide COUNTY with current certificates of insurance. All certificates of insurance must
provide for guaranteed thirty (30) days written notice to COUNTY of cancellation, non-renewal or material change. Any
modifying language in the insurance certificate must be deleted. Neither AHCCCSA nor COUNTY shall have any responsibility
or liability for any such insurance coverage obligations arising under this Agreement.
II.13 - CONFIDENTIALITY
Disclosure of information about a Member shall be limited to the Member, or to persons and agencies subject to the same confidentiality
restrictions and criteria as established by AHCCCSA. In no event shall information be disclosed except as provided by express
permission on Member or by law.
Ver 12/09 4
II.14 - INDEMNIFICATION
COMPANY shall indemnify, defend and hold harmless the COUNTY, its officers, departments, employees and agents from and against
any and all suits, actions, legal or administrative proceedings, claims, demands or damages of any kind or nature which result from the act
or omission of the indemnifying party, its agents, officers, employees or anyone acting under its direction or control.
II.15 - NON-APPROPRIATION
Notwithstanding any other provision in this Agreement, this Agreement may be terminated if for any reason the County Board of
Supervisors does not appropriate sufficient monies for the purpose of maintaining this Agreement. In the event of such cancellation,
COUNTY shall have no further obligation to COMPANY other than for services already provided, prior to notification of termination
from COUNTY.
II.16 - REMEDIES
Either party may pursue any remedies provided by law for the breach of this Agreement. No right or remedy is intended to be exclusive
of any other right or remedy and each shall be cumulative and in addition to any other right or remedy existing at law or at equity or by
virtue of this Agreement.
II.17 - NON-ASSIGNMENT
Any attempted assignment of this Agreement without the prior written consent of the COUNTY shall be void. This includes a merger,
reorganization or change in ownership. This Agreement shall be binding upon and inure to the benefit of the parties to this Agreement
and their respective successors and assigns.
II.18 - NON-WAIVER
The failure of either party to insist on any one or more instances upon the full and complete performance of any of the terms and
provisions of this Agreement to be performed on the part of the other, or to take any action permitted as a result thereof, shall not be
construed as a waiver or relinquishment of the right to insist upon full and complete performance of the same, or any other covenant or
condition, either in the past or in the future. The acceptance by either party of sums less than may be due and owing it at any time shall
not be construed as an accord and satisfaction.
II.19 - CONFLICT OF INTEREST

This contract is subject to cancellation for conflict of interest pursuant to A.R.S. §38-511, the pertinent provisions of which are
incorporated into and made part of this agreement as if set forth in full.
II.20 - INDEPENDENT CONTRACTORS

The status of COMPANY shall be that of an independent contractor and COMPANY shall not be considered an employee of COUNTY
and shall not be entitled to receive any fringe benefits associated with regular employment and shall not be subject to the provisions of the
COUNTY Merit System. COMPANY shall be responsible for payment of all federal, state and local taxes associated with compensation
received pursuant to this Agreement. COMPANY shall be responsible for program development and operation without supervision of the
COUNTY.
II.21 - HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

COMPANY acknowledges that COMPANY is a Business Associate of COUNTY as defined in 45 CFR § 160.103. As a Business
Associate, CONTRACTOR agrees to comply with the Health Insurance Portability and Accountability Act (HIPAA) requirements
established for the use and disclosure of individually identifiable and protected health information by a Business Associate as set forth
in the HHS Privacy Regulations, Code of Federal Regulations, Title 45, Parts 160 and 164. COMPANY further agrees to comply with
and be bound by all terms and conditions of the Business Associate as set forth in Appendix I of this Contract.
II.22 - OTHER DOCUMENTS

COMPANY and COUNTY in entering into this Contract have relied upon information provided in RFP # 1001249, Instructions to
Bidders, Standard Terms and Conditions, Specific Terms and Conditions, Solicitation Addenda, CONTRACTOR’S Proposal.
II.23 - SCRUTINIZED BUSINESS OPERATIONS

Pursuant to A.R.S. §§ 35-391.06 and 35-393.06, PROVIDER hereby certifies that it does not have scrutinized business operations in
Iran or Sudan. The submission of a false certification by PROVIDER may result in action up to and including termination of this
contract.
Ver 12/09 5
II.24 – NOTICES
Any notice required or permitted to be given under this Agreement shall be in writing and shall be served by delivery or by certified mail
upon the other party. Notice sent to the address for the recipient party set forth below:
Notice to COMPANY shall be addressed and mailed as follows:
Telephone # (520)
Fax # (520)
Notice to COUNTY shall be addressed and mailed as follows:
Pima Health System

Contracts Department
3950 S. Country Club Rd., Suite 300
Tucson, Arizona 85714
Telephone #: (520) 243-8000
Fax #: (520) 243-8311
Ver 12/09 6
ARTICLE III
PLAN PROVISIONS
III.1 - SERVICES
COMPANY shall furnish Pharmacy Benefit Manager and Pharmacy Services to PLAN Members as described in RFP 1001249 and
contained in Attachments B - B.2.
III.2 - COMPENSATION
The PLAN shall compensate COMPANY as contained in Attachment C.
III.3 - PAYMENT METHOD

A. Claim Submission for Paid Claims Transaction Fee: COMPANY must submit an invoice to the PLAN within ninety (90)
days from date of service.
B. Encounter and Claim Submissions for Pharmacy Claims: PROVIDER must submit claims, or encounters to the PLAN
within ninety (90) days from date of service or from date printed on Remittance Advice from Third Party payer. In no event
will claims, whether clean or otherwise, submitted more than two hundred ten (210) days from the date of service be accepted
or paid. PLAN agrees to pay PROVIDER within thirty (30) days after Clean Claim submission. Payment methodology for
United/Evercare Medicare Advantage members is addressed separately in Attachment D of this Agreement. PROVIDER
must submit individual claims or encounter forms for each Member on the appropriate form as set forth in the Pima Health
System Provider Manual, which is incorporated and made part of this Agreement by this reference, with all PLAN required
fields completed. Claims must reflect actual dates of service shown in the dates "To and From" portion of the appropriate
billing form. Bills that are not in a Clean Claim format will not be the responsibility of the COUNTY or the Member. Except
for applicable co-payments, PROVIDER shall not bill the Member for any Covered Services.
C. Third Party Liabilities: PLAN is the payer of last resort and PROVIDER must identify and bill other Third Party carriers
or insurers first. Claims involving Third Party coverage, including but not limited to Part A or Part B Medicare, must be
submitted with a complete copy of the other Third Party carrier’s Remittance Advice and any additional requirements as
stipulated by AHCCCS. Upon submission of Remittance Advice,, PLAN shall pay PROVIDER for the copayment,
coinsurance and deductibles for which Member is liable, up to the PLAN contracted rate for Dual Eligible Members. Refer
to the PLAN Standards and Procedures for exceptions and detailed Third Party billing information.
D. Denials: Payment for claims received within ninety (90) days of the date of service may be denied payment because of, but
not limited to the following reasons: lack of supporting documentation demonstrating that the service was actually
performed, lack of authorization or lapse in eligibility status (person not a Member on dates of service). PROVIDER must
submit corrected billing of paid, partially paid, denied or partially denied claims within sixty (60) days of Remittance Advice.
If PROVIDER feels the denial is not valid, PROVIDER may submit a request for Reconsideration by submitting additional
information to the PLAN, c/o Claims Review or file a Claim Dispute in writing, stating the factual and legal basis for the
Claim Dispute c/o PLAN’S Grievance Department.
E. Payment Recoupment: PROVIDER must pay PLAN upon demand or PLAN may deduct from future payments to
PROVIDER the following:
1. Any amounts received by PROVIDER from PLAN for Contract Services which have been inaccurately reported or are
found to be unsubstantiated.
2. Any amounts paid to PROVIDER by PLAN in excess of the compensation amount set forth in Attachment C.
If PROVIDER is in any manner in default in the performance of any obligation under this contract, or if audit exceptions are
identified, PLAN may, at its option and in addition to other available remedies, either adjust the amount of payment or
withhold payment until satisfactory resolution of the default or exception is made. Prior to any payment adjustment or
withhold, PLAN shall give PROVIDER ten business days advance written notice. PROVIDER may submit a written
explanation of its position within 10 business days of the date of PLAN’s notice. PLAN retains the right to withhold
payment, in whole or in part, until such time as PROVIDER remedies its default to PLAN’s satisfaction.
Ver 12/09 7
F. False Claims Act: In addition to all other applicable laws, rules, regulations, orders and ordinances, PROVIDER shall
comply with the provisions of the federal False Claims Act and any rules, regulations, or opinions promulgated thereunder or
derived therefrom. The False Claims Act prohibits fraud involving any federally funded contract or program, with the
exception of tax fraud. One purpose of this Act is to eliminate fraud, waste and abuse in Medicaid Programs. Activities
prohibited by the False claims act include knowingly presenting (or causing to be presented) a false or fraudulent claim for
payment, knowingly using (or causing to be used) a false record or statement to get a claim paid, conspiring with others to get
a false or fraudulent claim paid, and knowingly using (or causing to be used) a false record or statement to conceal, avoid, or
decrease an obligation to pay money or transmit property. Any entity that receives or makes annual Medicaid payments,
under the state plan, of at least $5 million shall establish written policies. By executing this Agreement, PROVIDER attests
that all employees, management and agents have received and read the written policies regarding the False Claims Act.
III.4 - SANCTIONS
A. Penalties: If PLAN is subject to penalties, under its Contract with AHCCCSA, due to default in the performance of COMPANY,
PLAN in its sole discretion may require COMPANY to either reimburse PLAN, or PLAN shall deduct the amount of the penalty
from future payments to COMPANY.
B. Liquidated Damages to PLAN: In the event of default by COMPANY in the performance of this Agreement, PLAN will notify
COMPANY, in writing, of such default. COMPANY will have thirty (30) days from the date of written notice to cure its default.
The damages incurred by PLAN from COMPANY’s default will necessarily be difficult to estimate therefore, if COMPANY is
unable, unwilling or otherwise fails to cure such default within thirty (30) days, PLAN may, in its sole discretion, assess
liquidated damages of up to $1,000 per each event of default occurring after the expiration of the 30 day notice period.
Ver 12/09 8
ARTICLE IV
ENTIRE AGREEMENT
This Agreement constitutes the entire Agreement between the parties and it may not be modified, amended, altered or extended except
through a written amendment signed by the parties.
IN WITNESS WHEREOF, the parties hereby approve this Agreement.
PIMA COUNTY COMPANY
Chairman, Board of Supervisors Name Here
Date Name and Title (please print)
Date
ATTEST:
Clerk of the Board
APPROVED AS TO FORM:
Deputy County Attorney
Ver 12/09 9
ATTACHMENT A
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM
AHCCCS AND ALTCS MINIMUM SUBCONTRACT PROVISIONS
OCTOBER - 2009
For the sole purpose of this Attachment, the following definitions apply:
“Subcontract” means any contract between the Contractor and a third party for the performance of any or all services or requirements
specified under the Contractor’s contract with AHCCCS.
“Subcontractor” means any third party with a contract with the Contractor for the provision of any or all services or requirements
specified under the Contractor’s contract with AHCCCS.
Subcontractors who provide services under the AHCCCS ALTCS and or the Acute Care Program must comply with the following
applicable rules and statutes:
• Rules for the ALTCS are found in Arizona Administrative Code (AAC) Title 9, Chapter 28. AHCCCS statutes for long term
care are generally found in Arizona Revised Statue (ARS) 36, Chapter 29, Article 2.
• Rules for the Acute Care Program are found in AAC Title 9, Chapter 22. AHCCCS statutes for the Acute Care Program are
generally found in ARS 36, Chapter 29, Article 1. Rules for the KidsCare Program are found in AAC Title 9, Chapter 31 and
the statutes for KidsCare Program may be found in ARS 36, Chapter 29, Article 4.
All statutes, rules and regulations cited in this attachment are listed for reference purposes only and are not intended to be all inclusive.
[The following provisions must be included verbatim in every contract.]
1. ASSIGNMENT AND DELEGATION OF RIGHTS AND RESPONSIBILITIES

No payment due the Subcontractor under this subcontract may be assigned without the prior approval of the Contractor. No
assignment or delegation of the duties of this subcontract shall be valid unless prior written approval is received from the Contractor.
(AAC R2-7-305)
2. AWARDS OF OTHER SUBCONTRACTS

AHCCCS and/or the Contractor may undertake or award other contracts for additional or related work to the work performed by the
Subcontractor and the Subcontractor shall fully cooperate with such other contractors, subcontractors or state employees. The
Subcontractor shall not commit or permit any act which will interfere with the performance of work by any other contractor,
subcontractor or state employee. (AAC R2-7-308)
3. CERTIFICATION OF COMPLIANCE – ANTI-KICKBACK AND LABORATORY TESTING

By signing this subcontract, the Subcontractor certifies that it has not engaged in any violation of the Medicare Anti-Kickback statute
(42 USC §§1320a-7b) or the “Stark I” and “Stark II” laws governing related-entity referrals (PL 101-239 and PL 101-432) and
compensation there from. If the Subcontractor provides laboratory testing, it certifies that it has complied with 42 CFR §411.361 and
has sent to AHCCCS simultaneous copies of the information required by that rule to be sent to the Centers for Medicare and Medicaid
Services. (42 USC §§1320a-7b; PL 101-239 and PL 101-432; 42 CFR §411.361)
4. CERTIFICATION OF TRUTHFULNESS OF REPRESENTATION

By signing this subcontract, the Subcontractor certifies that all representations set forth herein are true to the best of its knowledge.
5. CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988

The Clinical Laboratory Improvement Amendment (CLIA) of 1988 requires laboratories and other facilities that test human specimens
to obtain either a CLIA Waiver or CLIA Certificate in order to obtain reimbursement from the Medicare and Medicaid (AHCCCS)
programs. In addition, they must meet all the requirements of 42 CFR 493, Subpart A.
To comply with these requirements, AHCCCS requires all clinical laboratories to provide verification of CLIA Licensure or
Certificate of Waiver during the provider registration process. Failure to do so shall result in either a termination of an active provider
ID number or denial of initial registration. These requirements apply to all clinical laboratories.
Ver 12/09 10
Pass-through billing or other similar activities with the intent of avoiding the above requirements are prohibited. The Contractor may
not reimburse providers who do not comply with the above requirements (CLIA of 1988; 42CFR 493, Subpart A).
6. COMPLIANCE WITH AHCCCS RULES RELATING TO AUDIT AND INSPECTION

The Subcontractor shall comply with all applicable AHCCCS Rules and Audit Guide relating to the audit of the Subcontractor's
records and the inspection of the Subcontractor's facilities. If the Subcontractor is an inpatient facility, the Subcontractor shall file
uniform reports and Title XVIII and Title XIX cost reports with AHCCCS (ARS 41-2548; 45 CFR 74.48 (d)).
7. COMPLIANCE WITH LAWS AND OTHER REQUIREMENTS

The Subcontractor shall comply with all federal, State and local laws, rules, regulations, standards and executive orders governing
performance of duties under this subcontract, without limitation to those designated within this subcontract [42 CFR 434.70 and 42
CFR 438.6(l)].
8. CONFIDENTIALITY REQUIREMENT
The Subcontractor shall safeguard confidential information in accordance with federal and state laws and regulations, including but
not limited to, 42 CFR Part 431, Subpart F, ARS §36-107, 36-2903, 41-1959 and 46-135, AHCCCS Rules, the Health Insurance
Portability and Accountability Act (Public Law 107-191, 110 Statutes 1936), and 45 CFR Parts 160 and 164.
9. CONFLICT IN INTERPRETATION OF PROVISIONS

In the event of any conflict in interpretation between provisions of this subcontract and the AHCCCS Minimum Subcontract
Provisions, the latter shall take precedence.
10. CONTRACT CLAIMS AND DISPUTES

Contract claims and disputes arising under A.R.S Title 36, Chapter 29 shall be adjudicated in accordance with AHCCCS Rules and
A.R.S. §36-2903.01.
11. ENCOUNTER DATA REQUIREMENT

If the Subcontractor does not bill the Contractor (e.g., Subcontractor is capitated), the Subcontractor shall submit encounter data to the
Contractor in a form acceptable to AHCCCS.
12. EVALUATION OF QUALITY, APPROPRIATENESS, OR TIMELINESS OF SERVICES

AHCCCS or the U.S. Department of Health and Human Services may evaluate, through inspection or other means, the quality,
appropriateness or timeliness of services performed under this subcontract.
13. FRAUD AND ABUSE

If the Subcontractor discovers, or is made aware, that an incident of suspected fraud or abuse has occurred, the Subcontractor shall
report the incident to the prime Contractor as well as to AHCCCS, Office of Program Integrity. All incidents of potential fraud should
be reported to AHCCCS, Office of the Director, Office of Program Integrity.
14. GENERAL INDEMNIFICATION

The parties to this contract agree that AHCCCS shall be indemnified and held harmless by the Contractor and Subcontractor for the
vicarious liability of AHCCCS as a result of entering into this contract. However, the parties further agree that AHCCCS shall be
responsible for its own negligence. Each party to this contract is responsible for its own negligence.
15. INSURANCE
[This provision applies only if the Subcontractor provides services directly to AHCCCS members]
The Subcontractor shall maintain for the duration of this subcontract a policy or policies of professional liability insurance,
comprehensive general liability insurance and automobile liability insurance in amounts that meet Contractor’s requirements. The
Subcontractor agrees that any insurance protection required by this subcontract, or otherwise obtained by the Subcontractor, shall not
limit the responsibility of Subcontractor to indemnify, keep and save harmless and defend the State and AHCCCS, their agents,
officers and employees as provided herein. Furthermore, the Subcontractor shall be fully responsible for all tax obligations, Worker's
Compensation Insurance, and all other applicable insurance coverage, for itself and its employees, and AHCCCS shall have no
responsibility or liability for any such taxes or insurance coverage. (45 CFR Part 74) The requirement for Worker’s Compensation
Insurance does not apply when a Subcontractor is exempt under ARS 23-901, and when such Subcontractor executes the appropriate
waiver (Sole Proprietor/Independent Contractor) form.
Ver 12/09 11
16. LIMITATIONS ON BILLING AND COLLECTION PRACTICES
Except as provided in federal and state law and regulations, the Subcontractor shall not bill, or attempt to collect payment from a
person who was AHCCCS eligible at the time the covered service(s) were rendered, or from the financially responsible relative or
representative for covered services that were paid or could have been paid by the System.
17. MAINTENANCE OF REQUIREMENTS TO DO BUSINESS AND PROVIDE SERVICES

The Subcontractor shall be registered with AHCCCS and shall obtain and maintain all licenses, permits and authority necessary to do
business and render service under this subcontract and, where applicable, shall comply with all laws regarding safety, unemployment
insurance, disability insurance and worker's compensation.
18. NON-DISCRIMINATION REQUIREMENTS

The Subcontractor shall comply with State Executive Order No. 99-4, which mandates that all persons, regardless of race, color,
religion, gender, national origin or political affiliation, shall have equal access to employment opportunities, and all other applicable
Federal and state laws, rules and regulations, including the Americans with Disabilities Act and Title VI. The Subcontractor shall take
positive action to ensure that applicants for employment, employees, and persons to whom it provides service are not discriminated
against due to race, creed, color, religion, sex, national origin or disability. (Federal regulations, State Executive order # 99-4)
19. PRIOR AUTHORIZATION AND UTILIZATION MANAGEMENT

The Contractor and Subcontractor shall develop, maintain and use a system for Prior Authorization and Utilization Review that is
consistent with AHCCCS Rules and the Contractor’s policies.
20. RECORDS RETENTION

The Subcontractor shall maintain books and records relating to covered services and expenditures including reports to AHCCCS and
working papers used in the preparation of reports to AHCCCS. The Subcontractor shall comply with all specifications for record
keeping established by AHCCCS. All books and records shall be maintained to the extent and in such detail as required by AHCCCS
Rules and policies. Records shall include but not be limited to financial statements, records relating to the quality of care, medical
records, dental records, prescription files and other records specified by AHCCCS.
The Subcontractor agrees to make available at its office at all reasonable times during the term of this contract and the period set forth
in the following paragraphs, any of its records for inspection, audit or reproduction by any authorized representative of AHCCCS,
State or Federal government.
The Subcontractor shall preserve and make available all records for a period of five years from the date of final payment under this
contract unless a longer period of time is required by law.
If this contract is completely or partially terminated, the records relating to the work terminated shall be preserved and made available
for a period of five years from the date of any such termination. Records which relate to grievances, disputes, litigation or the
settlement of claims arising out of the performance of this contract, or costs and expenses of this contract to which exception has been
taken by AHCCCS, shall be retained by the Subcontractor for a period of five years after the date of final disposition or resolution
thereof unless a longer period of time is required by law. (45 CFR 74.53; 42 CFR 431.17; ARS 41-2548)
21. SEVERABILITY
If any provision of these standard subcontract terms and conditions is held invalid or unenforceable, the remaining provisions shall
continue valid and enforceable to the full extent permitted by law.
22. SUBJECTION OF SUBCONTRACT

The terms of this subcontract shall be subject to the applicable material terms and conditions of the contract existing between the
Contractor and AHCCCS for the provision of covered services.
23. TERMINATION OF SUBCONTRACT

AHCCCS may, by written notice to the Subcontractor, terminate this subcontract if it is found, after notice and hearing by the State,
that gratuities in the form of entertainment, gifts, or otherwise were offered or given by the Subcontractor, or any agent or
representative of the Subcontractor, to any officer or employee of the State with a view towards securing a contract or securing
favorable treatment with respect to the awarding, amending or the making of any determinations with respect to the performance of
the Subcontractor; provided, that the existence of the facts upon which the state makes such findings shall be in issue and may be
reviewed in any competent court. If the subcontract is terminated under this section, unless the Contractor is a governmental agency,
instrumentality or subdivision thereof, AHCCCS shall be entitled to a penalty, in addition to any other damages to which it may be
entitled by law, and to exemplary damages in the amount of three times the cost incurred by the Subcontractor in providing any such
gratuities to any such officer or employee. (AAC R2-5-501; ARS 41-2616 C.; 42 CFR 434.6, a. (6))
24. VOIDABILITY OF SUBCONTRACT
Ver 12/09 12
This subcontract is voidable and subject to immediate termination by AHCCCS upon the Subcontractor becoming insolvent or filing
proceedings in bankruptcy or reorganization under the United States Code, or upon assignment or delegation of the subcontract
without AHCCCS’s prior written approval.
25. WARRANTY OF SERVICES

The Subcontractor, by execution of this subcontract, warrants that it has the ability, authority, skill, expertise and capacity to perform
the services specified in this contract.
26. OFF-SHORE PERFORMANCE OF WORK PROHIBITED

Due to security and identity protection concerns, direct services under this contract shall be performed within the borders of the United
States. Any services that are described in the specifications or scope of work that directly serve the State of Arizona or its clients and
may involve access to secure or sensitive data or personal client data or development or modification of software for the State shall be
performed within the borders of the United States. Unless specifically stated otherwise in specifications, this definition does not apply
to indirect or “overhead” services, redundant back-up services or services that are incidental to the performance of the contract. This
provision applies to work performed by subcontractors at all tiers.
27. FEDERAL IMMIGRATION AND NATIONALITY ACT

The Subcontractor shall comply with all federal, state and local immigration laws and regulations relating to the immigration status of
their employees during the term of the contract. Further, the Subcontractor shall flow down this requirement to all subcontractors
utilized during the term of the contract. The State shall retain the right to perform random audits of Contractor and subcontractor
records or to inspect papers of any employee thereof to ensure compliance. Should the State determine that the Contractor and/or any
subcontractors be found noncompliant, the State may pursue all remedies allowed by law, including, but not limited to; suspension of
work, termination of the contract for default and suspension and/or debarment of the Contractor.
Ver 12/09 13
ATTACHMENT B
PHARMACY BENEFIT MANAGER (PBM)

SCOPE OF SERVICES
The COMPANY shall perform the following Pharmacy Benefit Manager functions:
1. Accept, process and upload member electronic eligibility daily, 7 days/week. The PBM must be able to update member
eligibility from the PLAN Information System and be capable of using this information to electronically process prescription
claims from the defined pharmacy network. The PBM will be required to accept member eligibility electronically from the
Plan Information System in the specified format as set forth in APPENDIX IV of this solicitation. The PBM must also have
the capability of adding, deleting or making changes to member eligibility on an individual basis 24 hours per day, 7 days per
week.
2. Accept date sensitive medical and prescriber provider transmissions on a weekly basis from the PLAN as set forth in
APPENDIX V of this solicitation.
Note: The Prescriber provider data file will be used if the Plan decides to have a closed prescriber provider network.
3. Transfer the claim data files to the PLAN twice a month; these files shall include at a minimum but not limited to, pharmacy
utilization, paid claims and reversed claims to the PLAN; see APPENDIX VI and VII for a sample of the required data fields
and formats for these transmissions.
4. Accept and process on-line, electronic, point of service, real time, prescription claims transactions from the contracted network
pharmacy.
5. Process for multiple accounts and groups of members (at least 8) established. Each member group should be differentiated by
positive formulary, pharmacy provider list, medical prescriber provider list, pricing structure and different levels of DUR type
edits as set forth in APPENDIX III of this solicitation.
6. Ensure that all pharmacy claims, when applicable, are identified for coordination of benefits with other payors and ensure that
the Plan is the payor of last resort with the exception of the Indian Health Service.
7. Edit claims within each of the groups for the following: member eligibility, formulary inclusion/exclusion, pharmacy and
medical prescriber provider inclusion/exclusion, pricing requirements, and DUR edits described as set forth in APPENDIX III
of this solicitation.
8. Provide an immediate electronic response to the prescription claims transaction transmission back to the contracted pharmacy
provider. Responses shall include and not limited to: Claim Status (either paid or rejected), Paid Claims must include the
payment amount and any related DUR messages, Rejected Claims must include a description of the reason for rejection:
member not eligible, non-formulary medication, prior authorization required, refill-too-soon, and other statements to assist the
contracted pharmacy in resolving the rejected claim and authorization expiration dates. Messaging to the pharmacy must also
identify other primary payors when the Plan is not the primary payor.
9. Provide PLAN with on-line, real-time capability to perform and/or review the following (must be able to document changes by
performing a print screen): review/add/change member eligibility, add change medical prescriber provider list, review/change
formulary, review/change DUR edits, add/change prior authorizations, review member claim history, review pharmacy
transmissions (by contracted pharmacy), access general drug files to review NDC lists and pricing, access general medical
prescriber provider files to check address and DEA and NPI numbers , access general pharmacy provider files to find address
and telephone numbers and NABP and NPI numbers, manually input pharmacy claims for payment to contracted pharmacies,
minimum of two (2) PLAN user ID’s.
10. Reconcile member group enrollees monthly, at a minimum, through the POSITIVE TRANSMISSION MEMBER FILE and
provide to PLAN within 24 hours an exception report for those members not matched.
11. Ability to set up contingent therapy edits and/or other clinically defined edits/ protocols, using refill history, ICD-9 codes,
allergies, etc.,
12. Capability to setup and implement ICD-10 by October 1, 2013.
Ver 12/09 14
ATTACHMENT B
PHARMACY BENEFIT MANAGER (PBM)

SCOPE OF SERVICES
CONTINUED
13. Assist the PLAN to reconcile and remediate any pharmacy encounters reported to AHCCCS that are pended.
14. The vendor must be able accept and respond to inquiries and prescriptions transmitted via an ePrescribing systems according to
NCPDP approved standards for ePrescribing. These currently can be found on the SureScriptsRxHub website and include:
• Prescription benefit information including patient eligibility and the health plan's formulary
• Patient medication history
• Bi-directional electronic routing of prescriptions which includes sending and receiving new and renewal prescriptions to
and from retail and mail order pharmacies.
The vendor must communicate new standards to the health plan and update their claims processing system to use and adhere to
these standards.
15. Provide reports as required by PLAN.
a) Drug Cost Ranking Summaries – Monthly & Quarterly

b) * Member Prior Authorization Detail- Monthly & Quarterly
c) * Members with 50 or More Claims – Monthly & Quarterly
d) * Members with 70 or More Claims Long Term Care – Monthly & Quarterly
e) * Members with 9 or More Controlled Drug Rx – Monthly & Quarterly.
f) * Members with More Than 1500 Dollars in Claims – Monthly & Quarterly.
g) * Members with More Than 3000 Dollars in Claims Long Term Care – Monthly & Quarterly.
h) * Rejected Prescription Claim Detail Report – Weekly & Monthly.
i) Pharmacy Provider Performance Summaries – Monthly & Quarterly
j) Prescriber Utilization Summary By Cost – Monthly & Quarterly
k) Prior Authorization Summary - Monthly & Quarterly
l) Therapeutic Class Detail – Monthly & Quarterly
m) Therapeutic Class Usage Summaries – Monthly & Quarterly
n) AHCCCS Mandated Data Reports – generally ad hoc
o) Copy of PLAN MAC list to be provided quarterly.
(The above reports are those generally required by the PLAN. The PLAN will review the Offerors standard reporting package
and may at its sole discretion accept minor variations on some of the report parameters.)
* Items b through h are expected in EXCEL or CSV format
PLAN reserves the right to request additional or modified reports if PLAN is subject to new requirements from AHCCCS.
The PBM will process the claims for payment and provide the claims data file to the PLAN. The PLAN will issue a check to
the PBM which in turn shall issue checks to the applicable contracted pharmacies unless an exception to this process is
mutually agreed upon for a specific pharmacy. PLAN shall make efforts to make pharmacy remittance advices in HIPPA
compliant 835 files.
Ver 12/09 15
ATTACHMENT B.1
PHARMACY CONSULTANT
SCOPE OF SERVICES
The COMPANY shall furnish the following Pharmacy Consultant services:
A. Clinical Services:
1. Formulary Management and Treatment Protocols:
• Oversight and management of PLAN’s Preferred Drug List and protocols.

• Quarterly review of PLAN’s Preferred Drug List and revise based on future utilization.
2. Prior Authorization Procedures:
• PLAN shall triage prior authorization requests; PBM shall make recommendations based on PHS Preferred Drug List
and protocols.
• PLAN shall utilize PBM’s pharmacist for the review and if appropriate, the approval process for submitted prior
authorization requests. Some prior authorization reviews may include contacting physicians, nurses and/or
pharmacies for information regarding the request.
• A prior authorization request that does not meet criteria can only be denied by a physician and therefore all potential
denials must be communicated to the PLAN as soon as identified..
• PLAN shall fax or communicate by phone: prior authorization form and relevant information to the PBM’s
pharmacist for review.
• PBM shall communicate approvals, suggestions or related communication to PLAN in HIPPA approved format.
• PBM’s pharmacist shall contact PLAN’s Medical Director via email and/or phone or by another mutually agreed
format in order to discuss individual claims or clinical issues and shall also consult with the PLAN’s Medical
Director to obtain final approval or denial of any prior authorization requests that involve high cost, appropriateness
of therapy or that require medical intervention.
• PBM shall provide the PLAN with the final approval or the potential denial of a prior authorization request in
accordance with AHCCCS required timeframes.
• PLAN shall enter prior authorization requests into the PLAN’s claims processing system
• PLAN shall contact pharmacy and/or other entities with approval/denial of all prior authorization requests.
• The PLAN shall send the Notice of Action (NOA) to the Member and to the prescribing clinician when a prior
authorization request has been denied. NOA letters are the responsibility of the PLAN. The PBM’s pharmacist will
assist the PLAN with the NOA process but the PBM shall not be responsible for the NOA preparation, wording or
submission.
• PLAN to provide report of prior authorization request approvals to the PBM’s consulting pharmacist for review on a
weekly basis via secure email or by other mutually agreed format, if requested.
3. AHCCCS Support:
• The PBM will assist the PLAN with requests, surveys or other requested data sent from AHCCCS including
Corrective Action Plans that involve pharmacy
4. Hours of Operation:
• PLAN’s helpdesk shall be available from 8:00 a.m. to 5:00 p.m., Monday through Friday.
• PBM’s pharmacist staff shall be available from 8:00 a.m. to 5:00 p.m., Monday through Friday.
• PBM’s helpdesk hours are from 7:00 a.m. to 5:00 p.m. (MST), Monday through Friday, as a minimum standard.
• PBM’s after-hours pharmacy helpdesk is available 24 hours a day, 7 days a week.
• After hours and On-call services are provided by the PBM at no charge to the PLAN.
Ver 12/09 16
ATTACHMENT B.1
PHARMACY CONSULTANT
SCOPE OF SERVICES
CONTINUED
5. Helpdesk Procedures:
• PLAN to maintain pharmacy helpdesk triage responsibilities

• PLAN and PBM shall develop a help desk document that addresses various situations that may arise with the member
and the resolution to these situations. Example, lost or stolen meds, vacation supplies, dosage changes, refill to soon,
etc.
• PLAN shall provide the PBM with outlined helpdesk policies and procedures to use in the event of vacation, sick
leave, or holiday coverage.
• PLAN shall coordinate and develop a process with the PBM to use when forwarding helpdesk phones to the PBM for
vacation, sick day leave coverage, or Holiday coverage.
B. Reporting:
The following clinical reports are required quarterly:
• Retrospective Drug Utilization Review (R-DUR) with analysis and correspondence.

• Controlled Medication Drug Utilization Review (DUR) with analysis and correspondence.
• Over/Underutilization Reporting with analysis and correspondence.
• Physician Report Card
C. Meetings:
• PBM’s pharmacist shall attend and present clinical material for review at quarterly Pharmacy and Therapeutics
(P&T) committee meetings.
• PBM shall be present at quarterly meetings to review PLAN’s drug expenditures and formulary management.
Ver 12/09 17
ATTACHMENT B.2
PHARMACY NETWORK
SCOPE OF SERVICES
A. The PBM shall require contracted network pharmacies to provide and supply medications (prescription and over the counter)
and medical supplies upon physician, physician’s assistant, nurse practitioner, or nurse mid-wife orders to PLAN members.
The contracted network pharmacies are required to provide the services identified below:
1. Interface electronically with the PLAN selected vendor for pharmacy claims processing.
2. Utilize the PLAN’s Formularies.
3. Provide generic equivalent drugs when commercially available for a brand name medication.
4. Fill 90% of all prescriptions within one (2) hours of request.
5. Urgent Requests must be filled within 1 hour after receiving the prescription.
6. Split billing capability for primary and secondary insurance payments and co-pay amounts.
7. HIPAA compliant interface.
8. Medicare billing capability including Medicare B billing on-line electronically.
9. Medical supply item capability.
10. Bubble packing capabilities as required.
11. Prescription and supply delivery options.
12. Open 365 days a year, 24 hours a day in desired areas of Pima and Santa Cruz counties. There must be provisions to
accommodate emergencies if there is not a 24 hour pharmacy available.
13. Pharmacy locations within three (3) blocks of public transportation in metro areas.
14. Pharmacies must have an active AHCCCS Provider Number at the time services are provided.
B. The PBM shall also:
1. Notify the Plan within two (2) business days of any changes in status of Pharmacy Network providers (e.g., closure,
ownership change, NPI change, contract status, regulatory issues, etc.).
2. Allow Plan contracted Pharmacy Provider to participate in PBM Pharmacy Network and PBM system.
3. Review the PLAN MAC list prices in relation to the State of Arizona/AHCCCS MAC list at least annually to ensure that
pricing on the PLAN MAC list reflects the lowest unit values possible.
PLAN is payer of last resort with the exception of the Indian Health Service. COMPANY may not bill PHS members for
services.
Ver 12/09 18
ATTACHMENT C
PRICING SHEET
A. Pharmacy Benefit Manager (PBM) Services (including pharmacist consulting services):
Pharmacy processing of electronically submitted prescription claims is paid at a rate of $ per PAID prescription claim
transaction. This amount must include, if any, cost of the switching fee for transmission. The pharmacy may not be billed any
additional fees for electronically submitting online prescription claims. There will not be a transaction fee for rejected claims.
PBM must bill PHS with the detailed number of transactions by member group and total. There will not be any additional
reimbursement for a mandatory generic substitution program.
Offeror must include cost of providing pharmacist consultative services (as outlined in the Scope of Services) into the prescription
paid transaction rate proposed above.
B. Prescription Drug Services including over-the-counter (OTC) and medically necessary supplies with physician order:
1. Reimbursement for brand name prescription products is the Average Wholesale Price (AWP) minus % or the usual
and customary (U&C) charge, whichever is less, plus the lesser of a contracted filling fee of One Dollar and Fifty Cents
($1.50) or submitted filling fee.
2. Reimbursement for generic prescription products is the PLAN’s MAC price or AWP minus % or the usual
and customary (U&C) charge, whichever is less, plus the lesser of a contracted filling fee of One Dollar and Fifty Cents
($1.50) or submitted filling fee.
3. Reimbursement for delivery of pharmaceuticals and/or supplies per site/per member authorized by PLAN is Six Dollars
($6.00).
(Note: LTC pharmacies are required to deliver medications at no charge)
4. Reimbursement for bubble packaging, per card, per PLAN authorized member is Fifty Center ($.50).
Note: Should ASP or AMP methodology be implemented by CMS, PLAN reserves the right to renegotiate price based on ASP or
AMP through a duly executed agreement.
Ver 12/09 19
APPENDIX I
BUSINESS ASSOCIATE AGREEMENT
WHEREAS, COUNTY entered into this Agreement on behalf of PLAN which is a “covered entity” as defined in 45 CFR §160.103;
and,
WHEREAS, COUNTY has determined that COMPANY is a “business associate” of COUNTY as defined in 45 CFR §160.103; and,
WHEREAS, the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A
and E require that an agreement be entered into specifying the ways in which COMPANY is permitted to use and disclose protected
health information which is provided by COUNTY;
NOW, THEREFORE, COMPANY agrees to comply with and be bound by the following Business Associate Agreement provisions:
1. Definitions. Terms used, but not otherwise defined in this Appendix shall have the same meaning as those terms in 45 CFR §
160.103 and § 164.501 as currently drafted or subsequently amended.
1.1 “Business associate” means COMPANY.
1.2 “Covered entity” means COUNTY’S Pima Health System AHCCCS and ALTCS plans.
1.3 “Individual” has the same meaning as the term “individual” in 45 CFR §164.501 and shall include a person who qualifies as a
personal representative in accordance with 45 CFR §164.502(g).
1.4 “Minimum necessary” means the standard as set forth in 45 CFR §164.502(b).
1.5 “PHI” means “protected health information” the term is defined in 45 CFR 164.501, limited to the information created or
received by the business associate from or on behalf of the covered entity.
1.6 “Privacy Rule” mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part
164, subparts A and E.
2. Permissive uses of PHI by business associate.
2.1 Services. Except as otherwise specified herein, business associate may make only those uses of PHI necessary to perform its
obligations under the Agreement provided that such use or disclosure would not violate the Privacy Rule if done by the
covered entity. All other uses not authorized by this Appendix are prohibited, unless agreed to in writing by COUNTY.
2.2 Activities. Except as otherwise limited in this Appendix, business associate may:
a) Use the PHI for the proper management and administration of the business associate and to fulfill any present or future
legal responsibilities of business associate provided that such uses are permitted under State and Federal confidentiality
laws.
b) Disclose the PHI to a third party for the proper management and administration of the business associate, provided that:
1) Disclosures are required by law; or,
2) Business associate obtains reasonable assurances from the third party that the PHI will remain confidential and not
be used or further disclosed except as required by law or for the purpose for which it was disclosed to that third
party and the third party notifies the business associate of any instances of which it is aware in which the
confidentiality of the PHI has been breached.
3. Obligations of business associate with respect to PHI.
3.1 With regard to use and disclosure of PHI provided by covered entity, business associate agrees not to use or further disclose
PHI other than as permitted or required by this Appendix or as required by law.
Ver 12/09 20
3.2 With regard to use and disclosure of PHI provided by covered entity, business associate further agrees to:
a) Use appropriate safeguards to prevent use or disclosure of PHI other than as provided for by this Appendix;
b) Mitigate, to the extent practicable, any harmful effect that is known to business associate of a use or disclosure of PHI by
business associate in violation of the requirements of this Appendix;
c) Report to covered entity, in writing, any use or disclosure of PHI not permitted or required by this Appendix of which it
becomes aware within fifteen (15) days of business associate’s discovery of such unauthorized use or disclosure;
d) Ensure that any agent, including a subcontractor, to whom business associate provides PHI agrees in writing to the same
restrictions and conditions on use and disclosure of PHI that apply to business associate;
e) Make available all records, books, agreements, policies and procedures relating to the use or disclosure of PHI to the
Secretary of HHS for purposes of determining covered entity’s compliance with the Privacy Rule, subject to applicable
legal privileges;
f) Make available, within seven (7) days of a written request, to covered entity during normal business hours at business
associate’s offices all records, books, agreements, policies and procedures relating to business associate’s use or
disclosure of PHI to enable covered entity to determine business associate compliance with the terms of this Appendix;
g) Provide access to PHI to the covered entity or the individual to whom PHI relates at the request of and in the time and
manner chosen by covered entity to meet the requirements of 45 CFR § 164.524;
h) Make any amendment(s) to PHI that covered entity directs pursuant to 45 CFR §164.526
i) Provide, within fifteen (15) days of a written request, to covered entity such information as is request by covered entity
to permit covered entity to respond to a request by an individual for an accounting of the disclosures of the individual’s
PHI in accordance with 45 CFR §164.528; and,
j) Disclose to subcontractors, agents or other third parties, and request from covered entity, only the minimum PHI
necessary to perform or fulfill a specific function required or permitted under the Agreement.
4. Term and Termination.
4.1 Term. This Appendix shall become effective on date approved by COUNTY and shall continue in effect until all obligations
of the Parties have been met, unless the Agreement is terminated as provided in Articles II.1, II.15 or II.19 or as provided in
this Section 4.
4.2 Termination by County. Upon COUNTY’S knowledge of a material breach or violation of the terms of this Appendix by
business associate COUNTY, in its sole discretion, may:
a) Immediately terminate the Agreement; or,
b) Provide business associate with an opportunity to cure the breach or violation within the time specified by COUNTY. If
business associate fails to cure the breach or end the violation within the time specified by COUNTY, then COUNTY
will either:
1) Terminate the Agreement; or,
2) If COUNTY determines termination is not feasible, report the breach or violation to the Secretary of HHS.
4.3 Effect of termination.
a) Upon termination of the Agreement, for any reason, business associate agrees to return or destroy all PHI, if it is feasible
to do so, and retain no copies thereof. Return or destruction shall occur within 60 days of the termination of the
Agreement. Business associate shall, upon return or destruction of PHI, provide written attestation to COUNTY that all
PHI held by business associate has been returned to COUNTY or has been destroyed.
Ver 12/09 21
b) Business associate further agrees to recover any PHI in the possession of its subcontractors, agents or third parties to
whom business associate has provided PHI and return or destroy such PHI within the 60 days after termination of the
Agreement. Business associate shall, upon return or destruction of PHI, provide written attestation to COUNTY that all
PHI held by business associate has been returned to COUNTY or has been destroyed.
c) If return or destruction of PHI is not feasible, business associate shall:
1) Notify covered entity in writing of the specific reasons why the business associate has determined it is infeasible to
return or destroy the PHI;
2) Agree to extend any and all protections, limitations, and restrictions contained in this Appendix to business associate
use and disclosure of any PHI retained after the termination of this Agreement; and,
3) Agree to limit any further uses and disclosures to those allowed under the Privacy Rule for the purposes that make
the return or destruction of PHI infeasible.
d) If it is not feasible for business associate to obtain PHI in the possession of a subcontractor, agent, or third party to whom
business associate has provided PHI, business associate shall:
1) Provide a written explanation to the covered entity why the PHI cannot be obtained;
2) Require the subcontractor, agent, or third party to agree, in writing, to extend any and all protections, limitations,
and restrictions contained in this Appendix to the subcontractor’s, agent’s, or third party’s use and disclosure of any
PHI retained after the termination of this Agreement; and,
3) Require the subcontractor, agent, or third party to agree, in writing, to limit any further uses and disclosures to those
allowed under the Privacy Rule for the purposes that make it infeasible for the business associate to obtain the PHI.
5. Miscellaneous.
5.1 Survival. Sections 4.3 and 2.1 solely with respect to PHI retained by the business associate in accordance with Section 4.3(c)
and 4.3 (d), shall survive the termination of the Contract for services between COUNTY and COMPANY.
5.2 Superseding Effect. Should the terms of this Appendix conflict with the terms of the Agreement, the terms providing for
more stringent protections of PHI shall apply. Nothing contained in this Appendix shall be held to vary, alter, waive or
extend any of the terms, conditions, provisions, agreements, or limitations of the Agreement other than as stated above in this
Appendix.
Ver 12/09 22

Pima County Notice of Request For Proposals (RFP)

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PIMA COUNTY NOTICE OF REQUEST FOR PROPOSALS (RFP)

Bonds are not required.

Fax: (520) 791-6511 email: [email protected]

USPO Mail to the following address:

VERBAL REQUESTS FOR CLARIFICATIONS OR INTERPRETATIONS WILL NOT BE ACCEPTED.

2. PRICING and OFFER DOCUMENTS

3. GENERAL SPECIFICATIONS & DEVIATIONS

4. OFFERORS MINIMUM QUALIFICATIONS

5. EVALUATION AND AWARD CRITERIA

CRITERIA MAXIMUM POINTS

The drug cost categories are as follows:

COST POINTS CALCULATION

1. Paid Claims Transaction Fee

2. Brand Name Drugs

B. Company Capability (0 to 30 points)

C. Finance Stability and Strength (0 to 10 points)

In Addition, Offeror shall complete Exhibit D: Financial Questionnaire.

INSTRUCTIONS TO OFFERORS (continued)

6.6 Exhibit E: Reference Form, fully completed as requested.

6.7 Exhibit F: Sustainability Questionnaire, fully completed as requested.

7. BEST AND FINAL OFFER

8. COMPLIANCE WITH AGREEMENT

10. VENDOR RECORD MAINTENANCE

END OF INSTRUCTIONS TO OFFERORS

6. ACKNOWLEDGEMENT AND ACCEPTANCE:

7. INTERPRETATION and APPLICABLE LAW:

12. SPECIFICATION CHANGES:

14. SHIPPING TERMS:

15. PAYMENT TERMS:

16. ACCEPTANCE OF MATERIALS AND SERVICES:

17. RIGHTS AND REMEDIES OF PIMA COUNTY FOR DEFAULT:

18. FRAUD AND COLLUSION:

19. COOPERATIVE USE OF RESULTING AGREEMENT:

20. PATENT INDEMNITY:

22. UNFAIR COMPETITION AND OTHER LAWS:

23. COMPLIANCE WITH LAWS:

25. CONFLICT OF INTEREST:

27. NON-APPROPRIATION OF FUNDS:

28. PUBLIC INFORMATION:

29. CUSTOM TOOLING, DOCUMENTATION AND TRANSITIONAL SUPPORT:

PIMA COUNTY STANDARD TERMS AND CONDITIONS (07/27/09)

30. AMERICANS WITH DISABILITIES ACT:

34. ORDER OF PRECEDENCE-CONFLICTING DOCUMENTS:

35. INDEPENDENT CONTRACTOR:

36. BOOKS AND RECORDS:

38. AUTHORITY TO CONTRACT:

39. FULL AND COMPLETE PERFORMANCE:

42. LEGAL ARIZONA WORKERS ACT COMPLIANCE

43. CONTROL OF DATA PROVIDED BY PIMA COUNTY:

END OF PIMA COUNTY STANDARD TERMS AND CONDITIONS

2. PIMA HEALTH SYSTEM SERVICES:

Enrollment for all PHS programs is found in Attachment C.

3.1 Attachment D Pharmacy Benefit Managers File Exchange Overview

3.2 Attachment E Pharmacy Benefit Manager (PBM) File Requirements

3.3 Attachment F On-Line Electronic Claim Requirement

3.4 Attachment G Plan Member Eligibility File Layout

3.5 Attachment H Prescriber Provider File Layout

3.6 Attachment I Paid Claim Proprietary File Layout

3.7 Attachment J Paid Claim 3.2 File Layout