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Task Task! ActivitylDescription Number <br />2 Enroll new providers. Conduct an enrollment site <br />visit to all new providers, and gather information <br />needed to complete Program enrollment <br />3 Use and facilitate provider use of the Washington <br />Immunization Information System to place and <br />approve provider vaccine orders. Monitor <br />provider orders for appropriateness (including: <br />accuracy of shipping information, order <br />frequency, timing, quantity and type) and approve <br />vaccine order online after assuring the <br />appropriateness ofthe order. <br />Exhibit A, Statements of Work <br />Revised as of November 15,2016 <br />*May Support PHAB Deliverables/Outcomes StandardslMeasures <br />I <br />Provider Agreement for <br />Receipt of State Supplied <br />Vaccine with original <br />signature -DOH 348-002 <br />(NOTE: a photocopy will not <br />be accepted) <br />I I <br />Electronic submission of <br />provider vaccine orders via the <br />Washington Immunization <br />Information System <br />Page 16 of21 <br />AMENDMENT #10 <br />Due DatelTime Frame Payment Information <br />and/or Amount <br />January 2017 - <br />March 2017 <br />FFY16 PPHF 317 Ops <br />-74110267 . <br />April 2017 - <br />December 2017 <br />FFY17 AFIX- <br />74110275 <br />*See Restrictions on <br />Funds below <br />Within ten (10) days after Reimbursement for <br />the date of the provider actual costs incurred, <br />enrollment visit not to exceed total <br />funding consideration <br />amount. <br />Funds available for <br />this task*: <br />January 2017 - <br />March 2017 <br />FFY16 PPHF 317 Ops <br />-74110267 <br />April 2017 - <br />December 2017 <br />FFY17 AFIX- <br />74110275 <br />*See Restrictions on <br />Funds below <br />Based on provider order Reimbursement for <br />schedules actual costs incurred, <br />not to exceed total <br />funding consideration <br />amount. <br />Funds available for <br />this task*: <br />Contract Number C 17114-10