Statement of The CONTRACTOR agrees to an audit conducted by an Annually Standard for independent CPA firm at the expense that is CONTRACTOR’S Attestation in accordance with the SSAE 16 and provides a copy of the Engagements report to the DEPARTMENT. CPA’s (SSAE) 16 Report 310 Deliverables As required by the CONTRACT, the CONTRACTOR must provide deliverables specified in the sections below. 310A Deliverables to the Department Instructions on submitting the deliverable and specific due dates will be provided by the DEPARTMENT annually. Deliverable Description Frequency Implementation Plan The CONTRACTOR submits an updated Within ten (10) implementation plan in a mutually agreed upon BUSINESS DAYS format and timeline to the DEPARTMENT of execution of Program Manager or designee. this CONTRACT Emergency Contact The CONTRACTOR provides the DEPARTMENT Within ten (10) Numbers with an emergency contact number for the BUSINESS DAYS Implementation Manager and Account Manager of execution of or backup in case issues arise that need to be this CONTRACT resolved outside of the aforementioned business hours. Fraud and Abuse Review The CONTRACTOR submits a fraud and abuse Within thirty (30) Plan review plan to the DEPARTMENT. DAYS of execution of this CONTRACT Identification (ID) Card The CONTRACTOR notifies the DEPARTMENT Upon identification Issuance Delays Program Manager of any delays with issuing the of issue ID CARDS. The CONTRACTOR sends a written confirmation ID CARD Confirmation January to the DEPARTMENT Program Manager indicating the date(s) the ID CARDS were issued. Key Contacts Listing The CONTRACTOR provides the DEPARTMENT April (ET-1728) with contact information for the key staff, which August the DEPARTMENT will share with EMPLOYERS. PARTICIPATING The CONTRACTOR provides an annual June submission to the DEPARTMENT containing their PHARMACY Submission for Upcoming Benefit network for the upcoming benefit period Period
Statement of Standard for Attestation Engagements (SSAE) 16 Report The CONTRACTOR agrees to an audit conducted by an independent CPA firm at the CONTRACTOR’S expense that is in accordance with the SSAE 16 and provides a copy of the CPA’s report to the DEPARTMENT. Annually 310 Deliverables As required by the CONTRACT, the CONTRACTOR must provide deliverables specified in the sections below. 310A Deliverables to the Department Instructions on submitting the deliverable and specific due dates will be provided by the DEPARTMENT annually. Deliverable Description Frequency Implementation Plan The CONTRACTOR submits an updated implementation plan in a mutually agreed upon format and timeline to the DEPARTMENT Program Manager or designee. Within ten (10) BUSINESS DAYS of execution of this CONTRACT Emergency Contact Numbers The CONTRACTOR provides the DEPARTMENT with an emergency contact number for the Implementation Manager and Account Manager or backup in case issues arise that need to be resolved outside of the aforementioned business hours. Within ten (10) BUSINESS DAYS of execution of this CONTRACT Fraud and Abuse Review Plan The CONTRACTOR submits a fraud and abuse review plan to the DEPARTMENT. Within thirty (30) DAYS of execution of this CONTRACT Identification (ID) Card Issuance Delays The CONTRACTOR notifies the DEPARTMENT Program Manager of any delays with issuing the ID CARDS. Upon identification of issue ID CARD Confirmation The CONTRACTOR sends a written confirmation to the DEPARTMENT Program Manager indicating the date(s) the ID CARDS were issued. January Key Contacts Listing (ET-1728) The CONTRACTOR provides the DEPARTMENT with contact information for the key staff, which the DEPARTMENT will share with EMPLOYERS. April August PARTICIPATING PHARMACY Submission for Upcoming Benefit Period The CONTRACTOR provides an annual submission to the DEPARTMENT containing their network for the upcoming benefit period June
Exhibit1_PBP_Agreement_Rev.docx