HomeMy WebLinkAboutJail Medical Services JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Mark McCauley, County Administrator
FROM: David Fortino
DATE: April 15,2024
SUBJECT: Contract—Quest Diagnostics Laboratories inc,Jail Medical Laboratory Services
STATEMENT OF ISSUE:
Contract for Laboratory services for jail medical purposes, billed on an as needed basis.
ANALYSIS:
FISCAL IMPACT:
Billing for services occurs on an as needed basis, fee schedule billed in accordance with the pricing terms
and conditions of the Premier GPO agreement.
RECOMMENDATION:
Approve Contract—Quest Diagnostics Laboratories inc,Jail Medical Laboratory Services
REVIEWED BY:
'eA 1 -52IF-l"2 x
Mark McC y, County Administ to Date
CONTRACT REVIEW FORM
(INSTRUCTIONS ARE ON THE NEXT PACE)
CONTRACT WITH: Quest Diagnostics Clinical Laboratories, Inc. 2024-1
(Name of Contractor/Consultant) Contract No.
COUNTY DEPARTMENT:
Contact Person: David Fortino
Contact Phone: 360-344-9743
Contact email: dfortino(cDeo.iefferson.wa.us
AMOUNT: o PROCESS:
Exempt from Bid Process
Revenue: Cooperative Purchase
Expenditure: Competitive Sealed Bid
Matching Funds Required: Small Works Roster
Sources(s) of Matching Funds Vendor List Bid
RFP or RFQ
Other:
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES COMPLIANCE WITH JCC 3.55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: � N/A: David Fortino Dal.202°�°Y1163 5.OTW 3/27/2024
Signature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
David Fortino Dgwy egnee by D"FOMM
CERTIFIED: N/A: Date:202403.2711:55:10-07W 3/27/2024
Signature Date
STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Laserfiche):
Electronically approved by Risk Management on 3/29/2024.
STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 3/28/2024.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
1
LABORATORY SERVICES AGREEMENT
(General)
THIS AGREEMENT,(the"Agreement")is effective as of the last date of signature below(the"Effective Date")is
by and between Quest Diagnostics Clinical Laboratories, Inc. ("Quest Diagnostics") and Jefferson County Jail
("Client").Quest Diagnostics and Client may be identified individually as a"Party"and collectively as the"Parties."
WITNESSETH
WHEREAS,Client desires to engage Quest Diagnostics to perform certain clinical laboratory services("Services"),
for Client's clinic and the clinic's patients, and Quest Diagnostics desires,pursuant to the terms and conditions set
forth herein,to provide such services;and
NOW THEREFORE, in consideration of the foregoing premises and mutual promises herein contained, and
intending to be bound legally hereby,Client and Quest Diagnostics agree as follows:
1 SERVICES.
1.1 Quest Diagnostics will provide Services for Client pursuant to orders by persons who are authorized under
state or federal law to order laboratory tests.
1.2 Supplies. Quest Diagnostics will provide to Client certain specimen collection supplies as part of its fees
for its Services hereunder to be used solely for the collection of specimens that are to be tested by Quest
Diagnostics.Client shall ensure that patient specimens referred to Quest Diagnostics are obtained in an
appropriate container and in adequate quantity,are properly processed,and are properly packaged for transport.
1.3 Quest Diagnostics will provide courier service to pick up specimens to be tested by Quest Diagnostics from
Client.
1.4 Quest Diagnostics will send reports back to Client either in an electronic format,subject to the execution by
the Parties of the applicable Quest Diagnostics'connectivity agreement,or via fax.
1.5 Services under this Agreement may be performed and billed by Quest Diagnostics or an entity that is now
or may in the future be controlled by or under common control with Quest Diagnostics.
2 COMPENSATION.
2.1 Quest Diagnostics will invoice Client in accordance with the specific needs of Client and applicable federal
and state statutes and regulations.
2.2 Where payment is due from Client to Quest Diagnostics,Client agrees to make payment to Quest
Diagnostics by check,ACH payment,certified money order,or electronic wire within thirty(30)days of the
date of each Quest Diagnostics invoice for Services,after which any undisputed unpaid invoice amounts will be
overdue. Where available,client will be invoiced monthly via Quest Diagnostics eInvoice(Quest web-based
invoicing system)or other similar electronic invoicing system.Paper invoices may incur additional fees.
Client's obligation to pay for Services rendered prior to termination of the Agreement will survive termination
of this Agreement.
2.3 Client will provide Quest Diagnostics with all necessary information required by Quest Diagnostics to
properly invoice and receive payment for Services. Client will ensure that such billing information accompanies
each specimen submitted for testing.
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2.4 All pricing contained herein and attached hereto as Attachment 1: Fee Schedule,will be in effect for one
(1)year from the Effective Date. Thereafter,Quest Diagnostics reserves the right to increase such pricing at
any time,but no more frequently than annually,upon thirty(30)days advance written notice to Client.
3 RECORDS.
Each Party agrees to maintain records for patients in such form and for such duration as may be required by Federal,
State or local statutes or regulations,and to make available to the Department of Health and Human Services,the U.S.
Comptroller General and their designees upon reasonable request and in a reasonable manner its books, documents,
and records relating to its provision of services under this Agreement as may be required by applicable statutes and
regulations.Quest Diagnostics acknowledges that these agencies and their designees have the right to audit,evaluate,
or inspect Quest Diagnostics' (or its subcontractors' or transferees')books, contracts, medical records, patient care
documentation,and other records,related to recipients of federal and state funds.
4 TERM.This Agreement will commence on the Effective Date and will continue in perpetuity until terminated as
set forth below.
5 TERMINATION.
5.1 Termination Without Cause. Either Party can terminate this Agreement upon thirty(30)days prior written
notice.
5.2 Termination With Cause.
5.2.1 Material Breach.Either Party may terminate this Agreement in the event of a material breach by
the other Party by giving the breaching party ten(10)days written notice identifying the breach. If the
breaching party fails to cure the breach within the ten(10)day cure period,the non-breaching party may
terminate the Agreement immediately upon written notice to the breaching party.
5.2.2 Material Change. Either Party may,upon written notice to the other Party,immediately terminate
this Agreement upon the occurrence of any of the following events:(i)the other Party makes an assignment
for the benefit of creditors;(ii)a petition in bankruptcy or any insolvency proceeding is filed by or against
the other Party and is not dismissed within thirty(30)days from the date of filing;(iii)all or substantially
all of the property of the other Party is levied upon or sold in any judicial proceedings;(iv)the other Party
is excluded from participating in any federally funded program;(v)a loss of licensure by the other Party
that renders the other Party unable to perform its obligations under this Agreement;or(vi)if the Party
determines in good faith that any portion of this Agreement may or does violate any law,rule,regulation or
governmental policy,or any interpretation of any law,rule,regulation or governmental policy.
6 SURVIVAL.
Those sections,which by the nature of their terms are intended to survive termination,or that contemplate
performance or observance after termination of this Agreement,will survive the termination or expiration of this
Agreement,including without limitation the following sections: Indemnification,Insurance, Miscellaneous,
Compliance with Law,Limitations of Liability,Terms of the Agreement,and Governing Law.
7 INSURANCE.
7.1 During the term of this Agreement,Quest Diagnostics will maintain,at its sole cost and expense,insurance
against claims that may arise from or in connection with the Services provided with at least the following
minimum limits of liability. Quest Diagnostics may provide the coverage required by this agreement through
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self-insurance.Quest Diagnostics will include Client as an additional insured for general liability and
automobile liability by a blanket additional insured endorsement,if applicable.
Coverage Type Minimum Limits of Liability
General Liability $2,000,000 per occurrence
$4,000,000 general aggregate
Business Automobile Liability $3,000,000 combined single limit per accident
Worker's Compensation Statutory-In accordance with the laws of the state exercising
jurisdiction over employees
Employers Liability $1,000,000 each accident/each employee/policy limit
Professional Liability/Errors& $5,000,000 each claim
Omissions Liability $5,000,000 aggregate
Crime $1,000,000 each occurrence
Cyber Liability $51000,000 each claim
7.2 Client will maintain,at its sole cost and expense,the following insurance coverages.
Coverage Type Minimum Limits of Liability
General Liability $1,000,000 per occurrence
$3,000,000 general aggregate
Business Automobile Liability $1,000,000 combined single limit
Worker's Compensation Statutory-In accordance with the laws of the state exercising
jurisdiction over employees
Employers Liability $1,000,000 each accident/each employee/policy limit
Professional Liability/Errors& $1,000,000 each claim
Omissions Liability $3,000,000 aggregate
Crime $1,000,000 each occurrence
Cyber Liability $1,000,000 each claim
7.3 Each Party will continue the coverage(or purchase"tail coverage")which will extend the reporting period
for incidents arising out of or related to this Agreement for at least three(3)years beyond the termination of this
Agreement. Upon request,each Party will provide the other Party with a current and valid Certificate of
Insurance evidencing coverage required by this agreement and annually thereafter. Cancellation notification is
in accordance with policy provisions.
7.4 Quest Diagnostics acknowledges that client's coverage is provided by the Washington Counties Risk Pool
and not traditional commercial insurance policies.
8 MISCELLANEOUS.
8.1 Independent Contractors.The Parties agree that each is an independent contractor engaged in the operation
of its own business.Nothing herein contained shall be construed to create a relationship of employer-employee
or master-servant,and any and all employees of a party engaged in the performance of any work or service
required under the Contract shall be considered employees of that party only and any claims that may arise on
behalf of or against said employees shall be the sole obligation and responsibility of that party.
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8.2 Assignment. Except in the event of a merger,consolidation,acquisition,or other transfer or change in
ownership or control of the Party,or as otherwise set forth in this Section,neither Party may transfer or assign
this Agreement nor any rights or obligations hereunder without the prior written consent of the other Party.
Notwithstanding the foregoing,Quest Diagnostics may refer work to an affiliated testing facility or to
subcontracted providers without prior written consent.This Agreement is intended to inure only to the benefit
of Quest Diagnostics and Client.
8.3 Trademarks.Neither party shall use the trademark,tradename,nor service mark of the other party for any
purpose without the prior written consent of the other party,however,Client authorizes the use of its name
and/or logo in furtherance of administering Services pursuant to this Agreement.
8.4 Entire Agreement.This Agreement constitutes the entire Agreement between the Parties with regard to the
subject matter hereof,supersedes all prior agreements or understandings and may only be modified in a writing
signed by both Parties. Notwithstanding the foregoing,if the Client is a member of a group purchasing
organization("GPO")with which Quest Diagnostics is under contract and the Client has complied with all
requirements under that GPO agreement to access the rates set forth and that GPO approved,the terms of the
GPO Agreement shall supersede any provisions of this Agreement.No modification of this Agreement will
have any force or effect unless such modification specifically indicates it is a modification of this Agreement,is
in writing and signed by authorized representatives of both Parties.
8.5 Notices.All notices under this Agreement will be delivered in accordance with this provision.Notice will
be deemed properly delivered,as of the date received by the non-noticing party,if given as follows:
• Notice to Quest Diagnostics will be via email to: CommercialContracting@questdiagnostics.com
• Notice to Client will be via traceable delivery method addressed as follows:
Jefferson County Jail
81 Elkins Rd.,Port Hadlock,WA 98339
ATTN: Spencer Patterson
Email:jaildoc@co.jefferson.wa.us
8.6 Governing Law.This Agreement shall be governed by the law of the state of Washington,without regard to
its conflict of laws provisions. In the event of any litigation between the parties arising out of this Agreement
the parties agree to waive the right to request a jury trial.
8.7 Force Majeure.No Party to this Agreement shall be liable for failure to perform any duty or obligation that
such Party may have under this Agreement where such failure has been caused by any event,foreseen or
unforeseen,outside the reasonable control of the Party who had the duty to perform and that renders
performance impossible or impracticable,including but not limited to:acts of God;acts of government;natural
disasters such as floods,earthquakes and severe weather events such as hurricanes; international or national
hostilities,including acts of war(declared or undeclared),insurrection,terrorism,mass casualty events or other
intentional violent actions;public health emergencies,including pandemic;fire;power failure;cyberattack or
ransomware attack;strike; lockout;riot;civil unrest,inevitable accident,inability to procure labor or materials;
or any other event,like or unlike those listed above(collectively,"Force Majeure Event")not within reasonable
control of the Party,but only to the extent prevented by the Force Majeure Event.No such failure or delay shall
excuse in any way the obligation of Client to make all payments to Quest Diagnostics provided for by this
Agreement.
8.8 Excluded Provider. Each party represents and warrants that it has not been convicted of a crime related to
healthcare or is not currently listed by a federal agency as debarred,excluded or otherwise ineligible for
participation in federally funded programs(including,without limitation,federally funded healthcare programs,
such as Medicare and Medicaid). If the foregoing representation changes during the term of this Agreement,
the affected party shall provide prompt written notice to the other party.
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8.9 Terms of the Agreement. Except as required by law,the terms of this Agreement(including without
limitation the pricing provisions)are confidential and may not be disclosed to third parties without the prior
written consent of both Parties. The provisions of this paragraph shall survive termination or expiration of this
Agreement.
8.1 ODisputes. The parties agree to use their best efforts to prevent and resolve disputes before they escalate into
claims or legal actions.If either party deem it necessary to institute legal action or proceeding to enforce any
right or obligation under the Contract,each party in such action shall bear the cost of its own attorney's fees and
court costs.Any legal action shall be initiated in the Superior Court of the State of Washington for Jefferson
County.The parties agree that all questions shall have the right of appeal from such decisions of the Superior
Court in accordance with the laws of the State of Washington.Quest Diagnostics hereby consents to the
personal jurisdiction of the Superior Court of the State of Washington for Jefferson County. The provisions of
this section shall survive the expiration or termination of the Contract.
9 LIMITATIONS OF LIABILITY.
In no event shall either party or its respective officers,directors,employees,agents affiliates,or volunteers be
liable for any special,exemplary,incidental,consequential or punitive damages,whether in contract,warranty,
tort,strict liability or otherwise. These limitations shall apply notwithstanding any failure of essential purpose
of any limited remedy and shall survive termination of this Agreement. Only to the extent not covered by
coverage by insurance and any deductible or self-insured retention the parties agree that Quest Diagnostics'
liability arising from or related to the provision of Services hereunder shall be limited to the actual amounts
paid to Quest Diagnostics pursuant to this Agreement in the twelve(12)months preceding the applicable claim.
10 COMPLIANCE WITH LAW.
Each of the Parties represents and warrants to the other Party that it will comply with all applicable laws, rules or
regulations ("Applicable Laws"), including, but not limited to, the federal Physician Self-Referral Law,42 U.S.C.
1395nn, and the regulations promulgated thereunder(together,the"Stark Law"),similar state physician self-referral
laws and regulations(together with the Stark Law, the "Self-Referral Laws"), the federal Medicare/Medicaid Anti-
kickback Law and regulations promulgated thereunder (the "Federal Anti-kickback Law") and similar state Anti-
kickback laws and regulations (together with the Federal Anti-kickback Law, the "Anti-kickback Laws") and the
Health Insurance Portability and Accountability Act("HIPAA"). This paragraph will survive the termination of this
Agreement.
11 INDEMNIFICATION.
Each party will indemnify,defend and hold the other party,its affiliates and their respective officers,directors,
employees,agents and volunteers(and their marital communities)harmless from and against any and all losses,
claims,suits,damages,liabilities and expenses(including without limitation,reasonable attorneys' fees and costs)
based upon or arising,directly or indirectly,from their respective negligent of willful acts or omissions,and the
negligent or willful acts or omissions of their affiliates and their respective officers,directors,employees,and
agents. Should a court of competent jurisdiction determine that the Contract is subject to RCW 4.24.115,then,in the
event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting
from the concurrent negligence of one party,and their affiliates and their respective officers,directors,employees,
and agents and volunteers(and their marital communities),the parties,including the duty and cost to defend,
hereunder shall be only to the extent of the other party's negligence. Each party specifically assumes potential
liability for actions brought against the other party by the other party's their respective officers,directors,
employees,and agents and volunteers,including all other persons engaged in the performance of any work or
service required of the Contractor under the Contract and,solely for the purpose of this indemnification and defense,
the parties specifically waive any immunity under the state industrial insurance law,Title 51 RCW.The parties
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recognize that this waiver was specifically entered into pursuant to provisions of RCW 4.24.115 and was subject of
mutual negotiation.
12 LEGISLATIVE/REGULATION CHANGES.
In the event federal or state legislative and/or regulatory changes impact the Services,either Party may seek to
amend this Agreement to fully comply with any legislative or regulatory changes.
13 SIGNATURE AUTHORITY.
The individuals signing this Agreement represent that they have the authority to sign this Agreement on behalf of
the respective Parties.
IN WITNESS WHEREOF,the Parties indicate their acceptance of the terms of this Agreement by having
their authorized representatives sign below.
JEFFERSON COUNTY WASHINGTON Quest Diagnostics Clinical Laboratories, Inc.
Board of County Commissioners
Jefferson County, Washington �u7�af7_Ma�c ttaGbor�t
By: Jean-Marc Ha[bout(Mar 25,202411:55 PDT)
By: Signature
Kate Dean, Chair Date
Name: Jean-Marc Halbout. Ph.D.
Title: Retzional President - West Region
By.Greg Brotherton, Commissioner Date Date: Mar 15. 2U14
By:
Heidi Eisenhour, Commissioner Date
SEAL:
ATTEST:
Carolyn Galloway, CMC Date
Clerk of the Board
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Appr�oved as to form only:
/C' March 28, 2024
Philip C. Hunsucker, Datc
Chief Civil Deputy Prosecuting Attorney
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00080 l 29.0
ATTACHMENT 1
FEESCHEDULE
In the event Quest Diagnostics bills Client,Client shall be billed in accordance with the pricing terms and conditions
of Premier GPO Agreement.
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DocuSign Envelope ID 300D18E5-40CC-4AB9-8lC1-4C76CO2A6577
AMENDED AND RESTATED EXHIBIT A-2
PARTICIPATING MEMBER DESIGNATION FORM
SELLER: Quest Diagnostics Incorporated
CONTRACT NUMBER: PP-LA-486
CONTRACT DATES: 10/l/2018-9/30/2026
SERVICE CATEGORY: Clinical Reference Laboratory Testing Services
1. Tier.The undersigned Participating Member hereby designates the following desired tier under the above-referenced Premier Healthcare Alliance,L.P.
Group Purchasing Agreement:
a. Select one Tier by initialing below
Number of Hot List Tests
Member TOTAL SERVICES PURCHASED Participating Members are Entitled to
Initials TIERS $PER CALENDAR YEAR Receive Additional Discounts For*
TIER 1 <$60,000 Min.10 Hot List Tests
TIER 2 $60,000 to<$360,000 Min.20 Hot List Tests
TIER 3 $360,000 to<$1,000,000 or Academic Health Systems Min.25 Hot List Tests
TIER 4 $1,000,000 to<$5,000,000 Min.35 Hot List Tests
TIER 5 $5,000,000 to<$I0,000,000 Min.40 Hot List Tests
TIER 6 $10,000,000 to<$20,000,000 Min.45 Hot List Tests
pF TIER 7 2$20,000,000 Min.50 Hot List Tests
TIER 8 Hot List Tests N/A
TIER 9 Send-Out Tests N/A
*Hot list test prices shall include additional discounts and may be locally negotiated
b. Seller shall not reduce a Participating Member's tier level without first(i)notifying the Participating Member and Premier in writing that the
Participating Member's purchase volume is below the tier level selected by the Participating Member(the"Tier Reduction Notice")and(ii)providing the
Participating Member thirty(30)calendar days from the date of notice to remedy the purchasing volume issues described in the Tier Reduction Notice.If
the Participating Member does not remedy the issues described in the Tier Reduction Notice within thirty(30)days,Seller may move the Participating
Member to the appropriate tier based on the Participating Member's Services purchased.Any tier adjustment pursuant to this paragraph that results in a less
favorable tier for the Participating Member will apply for Services purchased after the effective date of the tier reduction.
2. Azzreeation Pricing Option. By initialing where indicated below,the undersigned Participating Member or Participating Member group purchasing
organization("GPO'l hereby elects to invoke the Aggregation Pricing Option whereby such Participating Member which operates multi-facility systems
and has the ability to coordinate the purchasing decisions of such facilities,or such entity that has an established network of facilities for purposes of group
purchasing,shall be entitled to aggregate the purchasing volume within their respective systems and networks in order to meet the tier designated in Item 1
above contingent upon the Participating Members that operate multi-facility systems or have established networks of facilities for purposes of group
purchasing utilize Seller as their primary reference laboratory for those facilities that are aggregating their volume. In order to invoke this election,the
undersigned must be a Participating Member that is able to coordinate the purchasing decisions of the facilities it wishes to aggregate or a GPO with
members that are Participating Members.Attached hereto as Schedule l is a list of all such facilities.Seller shall be responsible for checking the
Discount and Rebate Reporting Assistance.Participating Member is advised that the programs provided in this Value Add Exhibit
may reflect discounts or rebates.Seller will assist Participating Member in the proper reporting of all rebates and discounts(actual or
proposed)provided under this Agreement.At a minimum,Seller will fully and accurately report any rebates and discounts provided to
Participating Member pursuant to this Value Add Exhibit and Agreement in a manner reasonably calculated to enable the Participating
Member to report the rebate and discount to payers.All rebates and discounts(actual or proposed)will be indicated on a written
invoice to the Participating Member Facility that notifies the recipient that the purchase is subject to a potential rebate that will be
reported when that rebate becomes known. Seller will not impede Participating Member's efforts to fully and accurately report all
rebates paid and discounts received.
At a minimum,Seller will provide Participating Member with a year-end reconciliation statement which:a.)reflects the percentage
discount and the total amount of the discount earned during the year for product classes purchased by Participating Member to which
the discount applies,and b.)advises the Participating Member to properly account for and report these discounts,consistent with 42
CFR Section 1001.952(h),which requires the purchaser of items and services covered under Medicare,Medicaid,and other Federal
healthcare programs to fully and accurately report any discounts,rebates and reductions in price in claims for payment and cost
reports submitted to the applicable federal or state agency.
Rev 08/17 Services Exhibit A-2 PMDF
PROPRIETARY AND CONFIDENTIAL Page l of
DocuSign Envelope ID:300D18E5-40CC-4AB9-8lC1-4C76CO2A6577
AMENDED AND RESTATED EXHIBIT A-2
PARTICIPATING MEMBER DESIGNATION FORM
SELLER: Quest Diagnostics Incorporated
CONTRACT NUMBER: PP-LA-486
CONTRACT DATES: 10/l/2018-9/30/2026
SERVICE CATEGORY: Clinical Reference Laboratory Testing Services
Membership Roster for updates as specified in Section 3.0 of the Agreement.—a ndersigned Participating Member or GPO hereby elects to invoke the
Aggregation Pricing Option:Participating Member's(or GPO's)Initials: PF
The undersigned Participating Member hereby acknowledges and confirms the above designations.
Participating Member/GPO Seller
Print Name of Person Signing David Fortino Print Name of Person Signing
Signature Dav4 F*+m Signature
Title of Person Signing Title of Person Signing
Phone Number (360) 344-9733 Date Signed
E-mail Address dfortino@co.jefferson.wa.us
Date Signed 02-27-2024
Entity Code AW3947
Print Name of Participating
Member/GPO Jefferson County .jail
Address 81 Elkins Rd
City and State Hadl ock WA 98339
Upon completion,please submit this form to both Seller and Premier.
Seller Information- Premier Information-
Fax:610.983.2010 Fax:704.8163509
Email:PremierPMDFnn.Premicrinc.com
SCHEDULEI
LIST OF PARTICIPATING MEMBER'S(or GPO's)FACILITIES
(For Purposes of Implementing the Aggregation Pricing Option)
[TO BE COMPLETED BY THE PARTICIPATING MEMBER OR GPO]
Participating Member/GPO name: Jefferson County Jail
Discount and Rebate Reporting Assistance.Participating Member is advised that the programs provided in this Value Add Exhibit
may reflect discounts or rebates.Seller will assist Participating Member in the proper reporting of all rebates and discounts(actual or
proposed)provided under this Agreement.At a minimum,Seller will fully and accurately report any rebates and discounts provided to
Participating Member pursuant to this Value Add Exhibit and Agreement in a manner reasonably calculated to enable the Participating
Member to report the rebate and discount to payers.All rebates and discounts(actual or proposed)will be indicated on a written
invoice to the Participating Member Facility that notifies the recipient that the purchase is subject to a potential rebate that will be
reported when that rebate becomes known.Seller will not impede Participating Member's efforts to fully and accurately report all
rebates paid and discounts received.
At a minimum,Seller will provide Participating Member with a year-end reconciliation statement which:a.)reflects the percentage
discount and the total amount of the discount earned during the year for product classes purchased by Participating Member to which
the discount applies,and b.)advises the Participating Member to properly account for and report these discounts,consistent with 42
CFR Section 1001.952(h),which requires the purchaser of items and services covered under Medicare,Medicaid,and other Federal
healthcare programs to fully and accurately report any discounts,rebates and reductions in price in claims for payment and cost
reports submitted to the applicable federal or state agency.
Rev 08/17 Services Exhibit A-2 PMDF
PROPRIETARY AND CONFIDENTIAL Page 2 of 3
DocuSign Envelope ID:300D18E5-40CC-4AB9-81C1-4C76CO2A6577
AMENDED AND RESTATED EXHIBIT A-2
PARTICIPATING MEMBER DESIGNATION FORM
SELLER: Quest Diagnostics Incorporated
CONTRACT NUMBER: PP-LA486
CONTRACT DATES: 10/1/2018-9/30/2026
SERVICE CATEGORY: Clinical Reference Laboratory Testing Services
Premier Participating Facility Name and City ST Phone Contact Name
Entity Supplier's Customer Account Number
Code Number
AW3947 Jefferson County Jail Hadlock WA 98339 (360) 344-9733 David Fortino
Discount and Rebate Reporting Assistance.Participating Member is advised that the programs provided in this Value Add Exhibit
may reflect discounts or rebates.Seller will assist Participating Member in the proper reporting of all rebates and discounts(actual or
proposed)provided under this Agreement.At a minimum,Seller will fully and accurately report any rebates and discounts provided to
Participating Member pursuant to this Value Add Exhibit and Agreement in a manner reasonably calculated to enable the Participating
Member to report the rebate and discount to payers.All rebates and discounts(actual or proposed)will be indicated on a written
invoice to the Participating Member Facility that notifies the recipient that the purchase is subject to a potential rebate that will be
reported when that rebate becomes known.Seller will not impede Participating Member's efforts to fully and accurately report all
rebates paid and discounts received.
At a minimum,Seller will provide Participating Member with a year-end reconciliation statement which:a.)reflects the percentage
discount and the total amount of the discount earned during the year for product classes purchased by Participating Member to which
the discount applies,and b.)advises the Participating Member to properly account for and report these discounts,consistent with 42
CFR Section 1001.952(h),which requires the purchaser of items and services covered under Medicare,Medicaid,and other Federal
healthcare programs to fully and accurately report any discounts,rebates and reductions in price in claims for payment and cost
reports submitted to the applicable federal or state agency.
Rev 08/17 Services Exhibit A-2 PMDF
PROPRIETARY AND CONFIDENTIAL Page 3 of 3