#08-5128 (Collier Health Sevices, Inc.)
A G R E E MEN T 08-5128
for
Pharmacy Services
THIS AGREEMENT, made and entered into on this -1 Lff" . day of Ar'; ,
2008, by and between Collier Health Services, Inc., authorized to do business in the State of
Florida, whose business address is 1454 Madison Avenue, Immokalee, Florida 34142,
hereinafter called the "Contractor" and Collier County, a political subdivision of the State of
Florida, Collier County, Naples, hereinafter called the "County":
WITNESSETH:
1. COMMENCEMENT. This Agreement shall commence on the date of award by the
Board of County Commissioners with an initial term of twelve (12) months
The County may, at its discretion and with the consent of the Contractor, renew the
Agreement under all of the terms and conditions contained in this Agreement for two
(2) additional terms of two (2) years each. The County shall give the Contractor written
notice of the County's intention to extend the Agreement term not less than ten (10)
days prior to the end of the Agreement term then in effect.
2. STATEMENT OF WORK. The Contractor shall provide Pharmacy Services in
accordance with the terms and conditions of RFP #08-5128 and the Contractor's
proposal referred to herein and made an integral part of this agreement and Exhibit A,
Scope of Work attached to and made an integral part of this agreement.
This Agreement contains the entire understanding between the parties and any
modifications to this Agreement shall be mutually agreed upon in writing by the
Contractor and the County project manager or his designee, in compliance with the
County Purchasing Policy and Administrative Procedures in effect at the time such
services are authorized.
3. COMPENSATION. The County shall pay the Contractor for the performance of this
Agreement the aggregate of the units actually ordered and furnished at the unit price,
together with the cost of any other charges/fees submitted in the proposal, and set forth
in Exhibit B, attached to and made an integral part of this Agreement.
Any County agency may purchase products and services under this contract, provided
sufficient funds are included in their budget(s).
Page 1 of 10
Payment will be made upon receipt of a proper invoice and upon approval by the
Project Manager or his designee, and in compliance with Chapter 218, Fla. Stats.,
otherwise known as the "Local Government Prompt Payment Act".
4. SALES TAX. Contractor shall pay all sales, consumer, use and other similar taxes
associated with the Work or portions thereof, which are applicable during the
performance of the Work.
5. NOTICES. All notices from the County to the Contractor shall be deemed duly served
if mailed or faxed to the Contractor at the following Address:
Collier Health Services, Inc.
1454 Madison Avenue
Immokalee, Florida 34142
Attention: Mike Ellis, Director of Corporate Development
Telephone: 239-658-3138
Facsimile: 239-658-3050
All Notices from the Contractor to the County shall be deemed duly served if mailed or
faxed to the County to:
Collier County Government Center
Purchasing Department - Purchasing Building
3301 Tamiami Trail, East
Naples, Florida 34112
Attention: Steve Carnell, Purchasing! GS Director
Telephone: 239-252-8371
Facsimile: 239-252-6584
The Contractor and the County may change the above mailing address at any time
upon giving the other party written notification. All notices under this Agreement must
be in writing.
6. NO PARTNERSHIP. Nothing herein contained shall create or be construed as creating
a partnership between the County and the Contractor or to constitute the Contractor as
an agent of the County.
7. PERMITS: LICENSES: TAXES. In compliance with Section 218.80, F.5., all permits
necessary for the prosecution of the Work shall be obtained by the Contractor. Payment
for all such permits issued by the County shall be processed internally by the County.
All non-County permits necessary for the prosecution of the Work shall be procured
and paid for by the Contractor. The Contractor shall also be solely responsible for
payment of any and all taxes levied on the Contractor. In addition, the Contractor shall
comply with all rules, regulations and laws of Collier County, the State of Florida, or the
Page 2 of 10
U. S. Government now in force or hereafter adopted. The Contractor agrees to comply
with all laws governing the responsibility of an employer with respect to persons
employed by the Contractor.
8. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any person to
use in any manner whatsoever, County facilities for any improper, immoral or offensive
purpose, or for any purpose in violation of any federal, state, county or municipal
ordinance, rule, order or regulation, or of any governmental rule or regulation now in
effect or hereafter enacted or adopted. In the event of such violation by the Contractor
or if the County or its authorized representative shall deem any conduct on the part of
the Contractor to be objectionable or improper, the County shall have the right to
suspend the contract of the Contractor. Should the Contractor fail to correct any such
violation, conduct, or practice to the satisfaction of the County within twenty-four (24)
hours after receiving notice of such violation, conduct, or practice, such suspension to
continue until the violation is cured. The Contractor further agrees not to commence
operation during the suspension period until the violation has been corrected to the
satisfaction of the County.
9. TERMINATION. Should the Contractor be found to have failed to perform his
services in a manner satisfactory to the County as per this Agreement, the County may
terminate said agreement immediately for cause; further the County may terminate this
Agreement for convenience with a thirty (30) day written notice. The County shall be
sole judge of non-performance.
, 10. NO DISCRIMINATION. The Contractor agrees that there shall be no discrimination as
to race, sex, color, creed or national origin.
11. INSURANCE. The Contractor shall provide insurance as follows:
A. Commercial General Liability: Coverage shall have minimum limits of $2,000,000
Per Occurrence, Combined Single Limit for Bodily Injury Liability and Property
Damage Liability. This shall include Premises and Operations; Independent
Contractors; Products and Completed Operations and Contractual Liability.
B. Business Auto Liability: Coverage shall have minimum limits of $300,000 Per
Occurrence, Combined Single Limit for Bodily Injury Liability and Property
Damage Liability. This shall include: Owned Vehicles, Hired and Non-Owned
Vehicles and Employee Non-Ownership.
C. Workers' Compensation: Insurance covering all employees meeting Statutory
Limits in compliance with the applicable state and federal laws.
D. Professional Liability: Coverage shall have minimum limits of $2,000,000 per
Occurrence.
Page 3 of 10
Special Requirements: Collier County shall be listed as the Certificate Holder and
included as an Additional Insured on the Comprehensive General Liability
Policy.
Current, valid insurance policies meeting the requirement herein identified shall
be maintained by Contractor during the duration of this Agreement. Renewal
certificates shall be sent to the County thirty (30) days prior to any expiration date.
There shall be a thirty (30) day notification to the County in the event of
cancellation or modification of any stipulated insurance coverage.
Contractor shall insure that all sub-Contractors comply with the same insurance
requirements that he is required to meet. The same Contractor shall provide
County with certificates of insurance meeting the required insurance provisions.
12. INDEMNIFICATION. To the maximum extent permitted by Florida law, the
Contractor shall indemnify and hold harmless Collier County, its officers and
employees from any and all liabilities, damages, losses and costs, including, but not
limited to, reasonable attorneys' fees and paralegals' fees, to the extent caused by the
negligence, recklessness, or intentionally wrongful conduct of the Contractor or anyone
employed or utilized by the Contractor in the performance of this Agreement. This
indemnification obligation shall not be construed to negate, abridge or reduce any other
rights or remedies which otherwise may be available to an indemnified party or person
described in this paragraph.
This section does not pertain to any incident arising from the sole negligence of
Collier County.
13. CONTRACT ADMINISTRATION. This Agreement shall be administered on behalf
of the County by the Housing and Human Services Department/Social Services
Program.
14. CONFLICT OF INTEREST: Contractor represents that it presently has no interest and
shall acquire no interest, either direct or indirect, which would conflict in any manner
with the performance of services required hereunder. Contractor further represents
that no persons having any such interest shall be employed to perform those services.
15. COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the attached
component parts, all of which are as fully a part of the contract as if herein set out
verbatim: Contractor's Proposal, Insurance Certificate, RFP #08-5128, Exhibit A, Scope
of Work and Exhibit B, Pricing.
16. SUBJECT TO APPROPRIATION. It is further understood and agreed by and
between the parties herein that this agreement is subject to appropriation by the Board
of County Commissioners.
Page 4 of 10
17. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES. No organization or
individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee,
service or other item of value to any County employee, as set forth in Chapter 112,
Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-05, and County
Administrative Procedure 5311. Violation of this provision may result in one or more
of the following consequences: a. Prohibition by the individual, firm, and! or any
employee of the firm from contact with County staff for a specified period of time; b.
Prohibition by the individual and! or firm from doing business with the County for a
specified period of time, including but not limited to: submitting bids, RFP, and! or
quotes; and, c. immediate termination of any contract held by the individual and! or
firm for cause.
18. IMMIGRATION LAW COMPLIANCE. By executing and entering into this
agreement, the Contractor is formally acknowledging without exception or stipulation
that it is fully responsible for complying with the provisions of the Immigration
Reform and Control Act of 1986 as located at 8 U.s.e. 1324, et seq. and regulations
relating thereto, as either may be amended. Failure by the Contractor to comply with
the laws referenced herein shall constitute a breach of this agreement and the County
shall have the discretion to unilaterally terminate this agreement immediately.
19. VENUE. Any suit or action brought by either party to this Agreement against the
other party relating to or arising out of this Agreement must be brought in the
appropriate federal or state courts in Collier County, Florida, which courts have sole
and exclusive jurisdiction on all such matters.
20. OFFER EXTENDED TO OTHER GOVERNMENTAL ENTITIES. Collier County
encourages and' agrees to the successful proposer extending the pricing, terms and
conditions of this solicitation or resultant contract to other governmental entities at the
discretion of the successful proposer.
21. AGREEMENT TERMS. If any portion of this Agreement is held to be void, invalid,
or otherwise unenforceable, in whole or in part, the remaining portion of this
Agreement shall remain in effect.
22. ADDITIONAL ITEMS/SERVICES. Additional items and! or services may be added to
this contract upon satisfactory negotiation of price by the Contract Manager and
Contactor.
23. DISPUTE RESOLUTION. Prior to the initiation of any action or proceeding permitted
by this Agreement to resolve disputes between the parties, the parties shall make a
good faith effort to resolve any such disputes by negotiation. The negotiation shall be
attended by representatives of Contractor with full decision-making authority and by
County's staff person who would make the presentation of any settlement reached
during negotiations to County for approval. Failing resolution, and prior to the
commencement of depositions in any litigation between the parties arising out of this
Agreement, the parties shall attempt to resolve the dispute through Mediation before
Page 5 of 10
an agreed-upon Circuit Court Mediator certified by the State of Florida. The mediation
shall be attended by representatives of Contractor with full decision-making authority
and by County's staff person who would make the presentation of any settlement
reached at mediation to County's board for approval. Should either party fail to
submit to mediation as required hereunder, the other party may obtain a court order
requiring mediation under section 44.102, Fla. Stat.
Any suit or action brought by either party to this Agreement against the other party
relating to or arising out of this Agreement must be brought in the appropriate federal
or state courts in Collier County, Florida, which courts have sole and exclusive
jurisdiction on all such matters.
24. KEY PERSONNEl/PROJECT STAFFING: The proposer's personnel and management
to be utilized for this project shall be knowledgeable in their areas of expertise. The
County reserves the right to perform investigations as may be deemed necessary to
insure that competent persons will be utilized in the performance of the contract. Firm
shall not change Key Personnel unless the following conditions are met: (1) Proposed
replacements have substantially the same or better qualifications and! or experience. (2)
that the County is notified in writing as far in advance as possible. Firm shall make
commercially reasonable efforts to notify Collier County within seven (7) days of the
change. The County retains final approval of proposed replacement personnel.
Page 6 of 10
IN WITNESS WHEREOF, the Contractor and the County, have each, respectively, by an
authorized person or agent, hereunder set their hands and seals on the date and year first above
written.
ATTEST:
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First Witness /. V, ~.
Sharon B. Aragona
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Second Witness
Victoria Carr
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Page 7 of 10
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
By: f:&~ d~.
Do a Fiala, Chairman
CoIIier Health Services, Inc.
B~L
Signature
Mike Ellis, Director of Community
Typed signature and title Development
EXHIBIT A
SCOPE OF WORK
1. Each of the Contractor's pharmacists must possess a current license from the Florida State
Board of Pharmacy in accordance with Revised Statutes of the State of Florida, and shall
maintain said license in good standing for the duration of the contract.
2. The Contractor shall provide at no additional cost to the county, pharmacy services at
locations in areas which are not evacuated during a disaster, and be prepared to accept
telephonic requests from the County Emergency Operations Center and fill such requests.
Collier County Housing and Human Services Department/Social Services Program will be
responsible for the pick-up and delivery of any such prescriptions.
3. The Contractor must be able to fill outpatient prescriptions as needed, each day for the
duration of the contract within normal work hours of 8 am to 5 pm.
4. The Contractor shall be able to provide Generic equivalent drugs when one is available to
fill the prescriptions. Prescriptions are limited to a 30-day supply.
5. The Contractor shall provide electronic transfer of invoices (billing) to a local PC by-mail
at least monthly per Clerk of Court's Finance standards. Such electronic data transfer
capability shall be operational within two (2) months of contract start-up and the first billing
shall be forthcoming within eight (8) weeks after start up of contract. The Contractor shall
provide a contact name and phone number for technical assistance when file format
problems arise.
6. The Contractor shall allow Collier County Housing and Human Services
Department/Social Services Program direct Internet access to pharmacy data base for client
profiles, prior authorizations, overrides, add! change client information, change eligibility
dates and ability to back date ending date, and contact name, telephone number and e-mail
address to advise of change of client's social security number.
7. The Contractor shall use File Transfer Protocol (FTP), or other HIP AA compliant
compatible programs to transfer encrypted client information (automatically) to pharmacy
database at least twice daily, without breaking security. Full file transfer shall be done
weekly. Contractor must comply with HIP AA 834 file format.
8. All of the Contractor's pharmacy locations shall be connected on a common network using
the same database in order to monitor patient information and manage the formulary. In
addition, all locations must be connected to the central system that contains client
information. All clients will be given a voucher to provide to the pharmacy. Any physician
can write a prescription; this includes Primary Care, specialists, emergency room physicians,
dentists, etc. Collier County Housing and Human Services/Social Services will not pay for
prescriptions if the client does not present a voucher which shows a valid begin and end date
of eligibility.
Page 8 of 10
9. Under the Health Insurance Portability and Accountability Act (HIP AA) of 1996,
Contractor is expected to adhere to the same standards as the County and other HIP AA
covered entities regarding the protection and non- authorized disclosure of Protected Health
Information (PHI).
10. It is highly desirable that the Contract Manager be a pharmacist. The Contract Manager
for Collier Health Services, Inc. will be Mike Ellis at telephone number 239-658-3138 and
email address mellis@collier.org.
11. The Contractor shall identify rebates that are forthcoming and any savings realized from
manufacturers rebates shall be credited against the County's monthly invoice.
12. Payments shall be made in accordance with the Local Government Prompt Payment Act
from a joint revolving account for the payment of services provided.
13. The Contractor shall fill all medications to patients for self-administration in accordance
with all applicable Federal, State and Local laws.
14. The Contractor shall update and make readily retrievable at any time, all outpatient and
drug data within the outpatient profile as each prescription is filled or refilled. The contractor
shall automatically monitor drug allergies and interactions according to data available for
each patient.
15. The Contractor shall provide monthly Utilization and Administrative reports including
number of prescriptions filled, covered individuals, utilizing individuals including physician
dispensing profiles and other reports.
16. The Contractor must immediately advise the County whenever abuse, drug seeking or
fraudulent behavior is suspected.
17. The Contractor shall provide to the County any manufacturer's no cost, discounted or
promotional health care items, which may be provided to them during the period of the
contract.
18. The Contractor shall be available for periodic site visits by Collier County staff, to any of
their locations, in order to monitor the quality of services provided.
19. The Contractor must respond within twenty-four (24) hours to all questions presented by
the Collier County Housing and Human Services Department.
20. The Contractor shall provide outpatient-packaging materials, including labeling, that
meets all applicable laws and regulations.
Labeling for outpatient packaging shaIl include:
Page 9 of 10
a. Patient Name
b. Date of Dispensing
c. Prescription Number
d. Physician's Name
e. Instructions for Patient Use
f. Name and Strength of Drug
g. Number of Doses Dispensed
21. The contractor shall maintain all outpatient drug profiles on a computerized dispersing
system.
Each outpatient drug profile must include:
a. Patient Name
b. Address
c. Phone
d. Birth Date/Social Security Number
e. Sex
f. Allergies
g. Prescription Number
Drug data within each outpatient drug profile must include:
a. Drug Name
b. Drug Strengths
c. Amount Ordered
d. Amount Dispensed
e. Instructions for Use
f. Refills Authorized
g. Physician Information
h. Times and Dates Filled
Electronic invoice data must include, but may not be limited to:
a. Patient Name (Last, First, MI)
b. SSN
c. NABP #
d. Store #
e. RX#
f. Date Filled (MM/DD/CCYY)
g. Refill
h. Physician Name
1. Drug
J. NDC # and Description
k. Quantity
I. Days Supply
m. Generic (Y IN)
n. Amount Due
o. Billing Date
Page 10 of 10
Cert ID 45253
ACORDn.
CERTIFICATE OF LIABILITY INSURANCE
DATE (MMIOOJYYYVI
3/30/2009
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO'RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
.m___.__________._____ ~_~~~~~~~..~~.I=g~DI~~ COVE~~.~..._._..__._'__Jn~~I~n~______.._.
INSURER A: Hartford Fire Ins~~ance Compan 119682
INSURER B: EarH.'?E.4...s:.~.!".~~.:L..~y_!!Jsurance _~~.__._._j-.~..~4..~~-----
INSURERC: ~_":.!.<:1gefield Empl~:r!,_Ins Co __u....!Q_Z.!l.!..___....__......_.
PRODUCER
Wells Fargo Ins Services Southeast, Inc.
27299 Riverview Center Blvd Suite 211
Bonita Springs FL 34134-4322
(239) 498-5225 (239) 949-3575
INSURED
collier Health Services, InC.
1454 Madison Avenue
Immokalee, FL 34142
i INSURER D:
i INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
~ ~~..-._-.._.-;:;:~-;::~~N."RA~-"-~----.-.. I PO~~~;:;~MBER P8H~Y &rJlD"€;rgf I Pg~~J~i,Rt~!fN i -.-----~;;;---.--..
GENERAL LIABILITY i EACH OCCURRENCE I $ I 000 000
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I I i $
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BODilY INJURY
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i BODILY INJURY
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. PROPERTY DAMAGE
(Per accident)
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i EMPLOYERS' LIABILITY :'I!"
i ANY PROPRIETORlPARTNERlEXECUTIVE
i -OFFICER/MEMBER EXCLUDED?
, If yes, describe under
SPECIAL PROVISIONS below
OTHER
I 4/1/2009
EACH OCCURRENCE
S 5.000,000
I $ --._._....?.!..~,<J.g..!..g.o..o.,..
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
I
Certificate Holder is Additional Insured as respects General Liability and lJmbrella Liability
Re: Agreement 08-5128 for Pharmacy Services
CERTIFICATE HOLDER
CANCELLATION
Collier County Board of County Commissioners
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
Naples, Florida
'MPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
/.- /r~ ""'j
x..JclQJ...:.
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
Page 1 of. 2
3/30/2009
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement{s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer{s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)
Page 2 of 2
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DEPARTMENT OF HEALTH &. HUMAN SERVrCES
Health Resources and Services
Administrati on
DEe 16 2008
Bureau of Primary Health Care
Rockville MD 20857
Reference:
Malpractice Liability Coverage - Renewal Health
Center Deeming Letter Coverage Effective
January 1, 2009 through December 3l, 2009
Dear Executive Director:
The Health Resources and Services Administration (HRSA) in
accordance with Section 224(g) of the Public Health Service
(PHS) Act, 42 U.S.C. ~233(g), as amended by the Federally
Supported Health Centers Assistance Act of 1995 (FSHCAA), (P.L.
104-73), deems the entities listed on the attachment(s)tQ be
employee's of the PHS, for the purposes of section 224,
effective January l, 2009. Section 224(a) provides liability
protection under the Federal Tort Claims Act (FTCA) for damage
for personal injury, including death, resulting from the
performance of medical, surgical, dental, and related functions
and is exclusive of any other civil action or proceeding.
The 1995 amendments to FSHCAA clarified that FTCA coverage
extends to deemed health centers and their: (1) officers; (2)
governing' board members; (3) full- and part-time health center
employees; (4) licensed or certified health care practitioner
contractors (who are not corporations) providing full-time
services (i.e., on ave~age at least 32 ~ hours per week); and
(5) licensed or certified health care practitioner contractors
(who are not corporations) providing part-time services in the
fields of family practice, general internal medicine, general
pediatrics, or obstetrics/gynecology. Volunteers are neither
employees nor contractors and, therefore, are not eligible for
FTCA coverage.
In addition, FTCA coverage is comparable to an "occurrence"
policy without a monetary cap. Therefore, any coverage limits
that may be mandated by other organizations are met.
This action is based on the assurances provided in your FTCA
deeming application, as required under 42 D.S.C. ~233(h}, with
regard .to: (1) implementation of appropriate policies and
procedures to reduce the risk of malpractice; (2)
implementation of a system whereby professional credent'ials
and privileges, references, claims history, fitness,
professional review organization findings, and licensure
status of health professionals are reviewed and verified; (3)
cooperation with the Department of Justice (DOJ) in the
defense of claims and actions to prevent claims in the future;
and (4) cooperation with DOJ in providing information related
to previous malpractice claims history.
Deemed health centers must continue to receive funding under
Section 330 of the PHS Act, 42 D.S.C. ~254(b), in order to
maintain FTCA coverage. If the deemed entity loses its
Section 330 funding, its coverage under the FTCA will end
immediately upon termination of the grant.
In addition to the FTCA statutory and regulatory requirements,
every deemed health center is expected to follow HRSA's FTCA-
related policies and procedures included on the enclosed list.
These documents can be found' online at
http://www.bphc.hrsa.gov/pinspals/default.htm.
For .further information, please contact the Office of Quality
and Data at 301-594-0818.
Sincerely,
1\.....u.. t.\.1.-.... J'I\ . b .
+-- James Macrae
Associate Administrator
Enclosure
Executive Director
Center for Family Health, Inc.
UDS# 057030
2298 Springport Road, Suite B
Jackson, MI49202
Battle Creek, MI49037
Executive Director
lake County Health Department
And Community Health Center
UOS# 058870
3010 Grand Avenue
Waukegan, IL 60085
Executive Director
Muskegon Family Care
UDS# 0516820
2201 South Getty Street
Muskegon Heights, MI49444
Executive Director
Community Clinic of Maui, Inc.
UDS# 096040
48 Lono Avenue
Kahului, HI 96732
Executive Director
Collier Health Services, Inc.
UDS# 041700
1454 Madison Avenue-West
lmmokafee, FL 34142
Executive Director
Unity Health System
UDS# 023890
39 Genesee Street
Rochester, NY 14611
Executive Director
Mattapan Community Health Center
UDS# 01201 0
1425 Blue Hill Avenue
Boston, MA 02126
Executive Director
JWCH Institute, Inc.
UDS# 0925360 .
1910 WestSunset Boulevard, Suite 650
Los Angeles, CA 90026
Executive Director
Northwest Buffalo Community Health Care Ctr
UDS# 020010
155 Lawn Avenue
Buffalo, NY 14207
Executive Director
Junta Del Centro De Salud Comunal
Or. Jose $, Belaval, Inc.
UOS# 020700
2003 Borinquen Avenue, P.O. Box 14457
San.Juan, PR 00916
Executive Director
Centro de Salud Familiar
Dr. Juli Palmieri Ferri, Inc.
UDS#020150
P.O. Box 450
Arroyo, PR 00714-11450
Executive Director
. Paterson Community Health Center, Inc.
UDS# 021300
32 Clinton Street
Paterson, NJ 07522
Executive Director .
Tri County Medical Center, tnc.
UDS# 042830
316 South Main Street, P.O. Box 726
Evergreen, AL 36401
Executive Director
CAMcare Health Corporation
UDS# 021280
817 Federal Street
Camden, NJ 08103
Executive Director
Chota Community Health Services, Inc.
UDS# 044251 0
1206 Hwy 411
Vonore, TN 37885
Executive Director
Scranton Primary Health Care Center, Inc,
UDS# 032560
'959 Wyoming Avenue, P.O. Box 31
Scranton, PA 18501-0031
Executive Director
Metro Community Provider Network'
UDS# 080730
3701 South Broadway
Englewood, CO 80113
Executive Director
Minnie Hamilton Health Care Center, Inc.
UDS# 034190
186 Hospital Drive
Grantsville, WV 26147~7100
Executive Director
Los Barrios Unidos Community Clinic, Inc.
UDS# 060680
809 Singleton Boulevard
Dallas, TX 75212
Executive Director
Covenant House Under 21
UDS# 021770
460 West 41st Street
New York, NY 10036-6801
Executive Director
Community Action Agency of Columbiana County, Inc.
UDS# 056820
7880 Uncole Place
Lisbon, OH 44432
Executive Director
Sebasticook Family Doctors
UDS# 015170
118 Moosehead Trail, Suite 5
Newport, ME 04953
Executive Director
Heritage Health & Housing, Inc.
[dba Heritage Health Care Center]
UDS#020130
1727 Amsterdam Avenue
New York, NY 10031
Executive Director
Morovis Community Health Center, Inc.
UDS# 022230
2 Calle Patron, P.O. Box518
Moroi/is, PR 00687
Executive Director
Family Healthcare Center
UDS# 083670
306 4lh street.North
Fargo, ND 58102
Executive Director
McKinney Community Health Center, Inc.
UDS# 048080
218 Quarterman Street
Waycross, GA 31503
Executive Director
Newark Community Health Centers, Inc.
UDS# 020500
741 Broadway
Newark, NJ 07104
Executive Director
. Southwest Community Health Center
UDS# 098790
751 Lombardi Court, Suite B
Santa Rosa, CA 95407
Executive Director
Yellowstone City County Health Department
UDS# 082500
123 South 27th Street
Billings, MT 59101
Executive Djr~ctor
Atascosa Health Center (AHC)
UDS# 062390
310 West Oaklawn Road
Pleasanton, TX 78064
Health Resources and Servioes Adm1nistration
Federal Tort Cla~s Act (FTCA)~Related
Program Assistance Letters (PALs)
And
Po1ioy. Infor.mation Notices (PINs)
This list highlights the PALs and PINs most relevant for FTCA-
related matters. Please consult HRSA's Web Site at
http://www.bphc.hrsa.gov/pinspals/default.htm for a listing of
all HRSA PALs and PINs.
PALs
1999-15
2005-0l
PINs
1999...,08
2001-1l
2001-16
200l-l9
2002-07
2002-22
2002-23
Questions and Answers on the Federal Tort Claims Act
Coverage for Section 330 Deemed Grantees
Federal Tort Claims ~ct Policy Clarification on Coverage
of Corporations Under Contract with Health Centers
Health Centers and the Federal Tort Claims Act
Clarification of Policy for Health Centers Deemed Covered
Under the Federal Tort Claims Act for Medical Malpractice
Credentialing and Privileging of Health Center
Practitioners
Procedure for Handling Subpoenas and Other Requests for
Testimony of Health Center Employees in Private Litigation
Scope of Project Policy
Clarification of Bureau of Primary Health Care
Credentialing and Privileging Policy Outlined in Policy
Information Notice 2001-l6
New Requirements for Deeming Under the Federally Supported
Health Centers Assistance Act
Updated: July 9,2007
ITEM NO.: ot~(2C'- aU7D
FILE NO.:
ROUTED TO:
OFF\CE Ot r~E " DATE RECEIVED:
COUNTY .pJ \ OnNE'l
10UQ ~PR \ 1 M'\ \ \: 0 (,
DO NOT WRITE ABOVE THIS LINE
REQUEST FOR LEGAL SERVICES
Date:
April 14, 2009
From:
Office of the County Attorney
Jeff Klatzkow
Lyn M. Wood, C.P.M., Contract specialist, .5t. A..^
Purchasing Department, Extension 2667 U-1(f'
To:
Re:
Contract: 08-5128 "Pharmacy Services"
Contractor: Collier Health Services, Inc.
BACKGROUND OF REQUEST:
This Contract was approved by the BCC on April 14, 2009, Agenda
Item 16.0.9
This item has not been previously submitted.
ACTION REQUESTED:
Contract review and approval.
OTHER COMMENTS:
Please forward to BCC for signature after approval. If there are any
questions concerning the document, please contact me. Purchasing would
appreciate notification when the documents exit your office. Thank you.
C: Terri Daniels, Human Services
/
~~. ~~~ 01:&J
r vl* ~
RLS#
CHECKLIST FOR REVIEWING CONTRACTS
Entity Name: ~~V1f ~)l-v5J /H.J::-.
Entity name correct on contract? ',- ~t/.. U ~ :;:Y es _No
Entity registered with FL Sec. of State? . ( If) _Yes (L--No
lA ~_eAPlt)tt'\~/J ,t..l/:/)"S .co#1
Insurance . ~TV"()':';' -
Insurance Certificate attached? ~ es
Insured registered in Florida? -Q..,es
Contract # &/or Project referenced on Certificate? ~;: es
Certificate Holder name correct (BCC)? ~ Yes
Commercial General Liability
General Aggregate Required $
Products/Compl/Op Required $J.iidJ/fJiJD
Personal & Advert Required $
Each Occurrence Required $ d.i/J(.[}/J/JO
Fire/Prop Damage Required $ ,
Automobile Liability
Bodily Inj & Prop Required ~~BtV
Workers Compensation . u..e-.f)pv!
Each accident Required $E Provided $
Disease Aggregate Required $ Provided $
Disease Each Empl Required $ Provided $
Umbrella Liability '5/Jl)'1J fl/iJ
Each Occurrence Provided $ , J 10.
Aggregate Provided $ - ftrnmtWi;
Does Umbrella sufficiently cover any underinsured portiA!. '
Professional Liability
Each Occurrence Required $ 2,OtJgOft) Provided $ e
Per Aggregate Required $ _~ Provided $
Other Insurance /'
Each Occur Type: /
Provided $ h/((tJtJ$t!tJ
Provided $ 1J!JOIJ;f)fJ.O
Provided $ ~
Provided $ ~ ;()O
Provided $
.JJ
Wr
Provided $ .UJ& 0. otJ1J
I I
Exp Date
Exp Date
Exp Date
Exp Date
Exp Date
Exp Date
----,--Yes
<1-1/ Jot 0
tf-r-~tJIO
No
Exp. Date
Exp. Date
~~
~';::;i'.
1Jff;t~P
Exp Date_
Required $
Provided $
County required to be named as additional insured? ~es No
County named as additional insured? Yes No
Indemnification
Does indemnification meet County standards? Yes No
Is County indemnifying other party? Yes No
Peiformance Bond
Bond requirement referenced in contract? - Yes No
If attached, expiration date of bond
Does dollar amount match contract? Yes No
Agent registered in Florida? Yes No
Signature Blocks
Correct executor name in signature block? - Yes No
Correct title of executor? Yes No
Executor authorized to sign for entity? _Yes No
Proper number of witnesses/notary? Yes No
Authorization for executor to sign, if necessary:
Chairman's signature block? Yes No
Clerk's attestation signature block? Yes No
County Attorney's signature block? Yes No
Attachments
Are all required attachments included? _Yes No
Reviewer Initials: {2We,
Date: 4-17-'09
04-COA-0 1 030/222
MEMORANDUM
TO:
FROM:
Ray Carter
Risk Management Department
Lyn M. Wood, C.P.M., Contract Specialist .J!l
Purchasing Department ~
DATE:
April 14, 2009
RE:
Review Insurance for Contract: 08-5128 "Pharmacy Services"
Contractor: Collier Health Services, Inc.
This Contract was approved by the BCC on April 14, 2009, Agenda Item
16.D.9
Please review the Insurance Certificates for the above referenced contract. If
everything is acceptable, please forward to the County Attorney for further
review and approval. Also, will you advise me when it has been forwarded.
Thank you. If you have any questions, please contact me at extension 2667.
dod/LMW
C: Terri Daniels, Human Services
DATE RECEIVED
APR 1 5 2009
RISK MANAGEMENT
~i;7J9
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No Name History
Detail by Entity Name
Florida Non Profit Corporation
COLLIER HEALTH SERVICES, INC.
Filing Information
Document Number 739050
FEI Number 591741277
Date Filed 05/17/1977
State FL
Status ACTIVE
Last Event AMENDMENT
Event Date Filed 03/29/1999
Event Effective Date NONE
Principal Address
1454 MADISON AVE WEST
IMMOKALEE FL 34142 US
Changed 01/19/2007
Mailing Address
POBOX 873
IMMOKALEE FL 34143 US
Changed 04/08/1998
Registered Agent Name & Address
DILLON, WILLIAM
2618 CENTENNIAL PL
TALLAHASSEE FL 32308 US
Name Changed: 06/21/1999
Address Changed: 03/03/2008
Officer/Director Detail
Name & Address
Title ST
IRIZARRY, D1GNA
106 S 1ST STREET SUITE 101
IMMOKALEE FL 34142 US
Title C
BLACKBURN, DORIS
5203 SELBY DRIVE
FORT MYERS FL 33919 US
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Title VD
ALLEN SR, HOWARD
430 GAUNT STREET
IMMOKALEE FL 34142
Title EV
WEINMAN, STEVEN 0
1454 MADISON AVENUE
IMMOKALEE FL 34142
Title PCEO
AKIN, RICHARD B
1454 MADISON AVENUE
IMMOKALEE FL 34142
Title VP
ARAGONA, SHARON B
1454 MADISON AVENUE
IMMOKALEE FL 34142
Annual Reports
Report Year Filed Date
2007 01/19/2007
2007 10/01/2007
2008 03/03/2008
Document Images
03/03/2008 -- ANNUAL REPORT
10/01/2007 -- ANNUAL REPORT
01/19/2007 -- ANNUAL REPORT
03/20/2006 - Reg,. Agentcoange
01/17/2006 -- ANNUAL REPORT
07/1$)2005 -- AtiN UAL Ii.EEQBT
9J1J4/2005 -- ANNlJALREPORT
OS/2_5/2904 -- ANNJ,J.A!,.-':~EP_ORI
04/3012003-- ANNUAL REPORT
OZI1"1,!2002.=ANN,lJA.LR.!;PORI,,
QQ!11/2001 --ANNUALREPORI
93!H!200Q=,ANNUA.L,g!;PORI
06/21/1999 -- ANNUAL REPORT
03!29I1,999.=.Amendment
02/01/1999 -- Reg. Agent Change
04/08/1998 -- ANNUAL REPORT
04/30/1997 -- ANNUAL REPORT
05/16/1996 -- ANNUAL REPORT
05/01/1995 -- ANNUAL REPORT
Note: This is not official record. See documents if question or conflict.
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