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Task Number Task! Activity/Description 2 Enroll new providers. Conduct an enrollment site visit to all new providers, and gather information needed to complete Program enrollment 3 Use and facilitate provider use of the WA lIS to place and approve provider vaccine orders. Monitor provider orders for appropriateness (including: accuracy of shipping information, order frequency, timing, quantity and type) and approve vaccine order online after assuring the appropriateness of the order. 4 Monitor and assure electronic or paper submission of vaccine accountability reports for compliance with Provider Agreement related to vaccine management (ordering, inventory Exhibit A, Statements of Work Revised as of November 16 ,2015 *May Support PHAB Standards/Measures Deliverables/Outcomes a) Provider Agreement for Receipt of State Supplied Vaccine with original signature -DOH 348- 002 (NOTE: a photocopy will not be accepted) Electronic submission of provider vaccine orders via the WAilS. a) Monthly Vaccine Accountability Report (DOH 348-006), submitted by email or online in the WAilS. Page 4 of 10 AMENDMENT #5 Payment Due Date/Time Frame Information and/or Amount *See Restrictions on Funds below Within ten (10) days after Reimbursement for the date of the provider actual costs incurred, enrollment visit not to exceed total funding consideration amount. Funds available for this task*: FFY16 AFIX, 74110265 *See Restrictions on Funds below Based on provider order Reimbursement for schedules actual costs incurred, not to exceed total funding consideration amount. Funds available for this task*: FFY16 VFC Vaccine Ordering 74110264 FFY 16 VFC Ops 74110263 FFY 16 317 Ops 74110261 *See Restrictions on Funds below a) By the 15th of each Reimbursement for month actual costs incurred, not to exceed total funding consideration Contract Number C17114-5