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Task *May Support PHAB Payment <br />Number Task! Activity /Descri ption StandardslMeasures Deliverables/Outcomes Due DatelTime Frame Information and/or <br />Amount <br />*See Restrictions on <br />Funds below <br />2 Enroll new providers. Conduct an enrollment a) Provider Agreement for Within ten (10) days after Reimbursement for <br />site visit to all new providers, and gather Receipt of State Supplied the date of the provider actual costs incurred, <br />information needed to complete Program Vaccine with original enrollment visit not to exceed total <br />enrollment, per instructions at this link signature (NOTE : a photocopy funding consideration <br />will not be accepted) amount. <br />: . <br />b) Provider Agreement Funds available for <br />(DOH 348-022) this task*: <br />c) lIS Information Sharing FFY15 AFIX, <br />Agreement 74205250 <br />d) Account Application *See Restrictions on <br />Funds below <br />e) User Account Worksheet <br />3 Use and facilitate provider use ofthe Electronic submission of provider Based on provider order Reimbursement for <br />Washington Immunization Information System vaccine orders via the Washington schedules actual costs incurred, <br />to place and approve provider vaccine orders. Immunization Information System not to exceed total <br />Monitor provider orders for appropriateness funding consideration <br />(including: accuracy of shipping information, amount. <br />order frequency, timing, quantity and type) and . <br />approve vaccine order online after assuring the Funds available for <br />appropriateness of the order. this task*: <br />I <br />FFYl5 VFC Vaccine <br />Ordering I <br />74204250 I <br />FFY I 5 VFC Ops <br />74203250 <br />FFY 317 Ops <br />74201250 <br />*See Restrictions on <br />Funds below <br />4 Monitor and assure electronic or paper a) Monthly Vaccine a) By the 15th of each Reimbursement for <br />submission of vaccine accountability reports for Accountability Report month actual costs incurred, <br />compliance with Provider Agreement related to (DOH 348-006), submitted by not to exceed total <br />vaccine management (ordering, inventory e-mail or online in the lIS <br />------ <br />_funding consideration <br />Exhibit A, Statements of Work Page 15 of 19 Contract Number C 17114