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DOH Program Name or Title: Office of Immunization & Child Profile - <br />Effective January 1, 2018 <br />SOW Type: Original Revision # (for this SOW) <br />Exhibit A <br />Statement of Work <br />Contract Term: 2018-2020 <br />Local Health Jurisdiction Name: Kittitas County Public Health Department <br />Contract Number: CLH18249 <br />Funding Source Federal Compliance Type of Payment <br />1:8] Federal Subrecipient (check if applicable) 1:8] Reimbursement <br />D State 1:8] FFATA (Transparency Act) D Fixed Price <br />D Other o Research &_Development <br />Period of Performance: January 1, 2018 through June 30, 2018 <br />Statement of Work Purpose: The purpose of this statement of work is to define required immunization tasks, deliverables, and funding for the period January 1,2018 through <br />June 30, 2018 . <br />Revision Purpose: N/ A <br />Chart of Accounts Program Name or Title CFDA# BARS Master Funding Period Current Change rrotal <br />Revenue Index (LHJ Use Only) Consideration Increase (+) [consideration <br />Code Code Start Date End Date <br />FFY 17 VFC Ops 93.268 333 .93.26 74310271 01101118 06/30/18 0 1,114 1,114 <br />FFY17 317 Ops 93.268 333 .93 .26 74310270 01101118 06/30/18 0 616 616 <br />FFY17 AFIX 93.268 333.93.26 74310272 01101/18 06/30/18 0 2,226 2,226 <br />'" <br />TOTALS 0 3.956 3,956 <br />Task *May Support PHAB Due Date/Time Payment <br />Task! ActivitylDescription Deliverables/Outcomes Information and/or Number StandardslMeasures Frame Amount <br />Perform accountability activities in accordance with state and federal requirements for the Vaccines for Children (VFC) Program as outlined in the Centers for Disease Control <br />and Prevention (CDC) VFC Operations Guide and as directed by the state administrators of the VFC program. Accountability requirements include, but are not limited to: <br />provider education, provider site visits and required corrective action, quality assurance activities, VFC screening, satisfaction survey, outside provider agreements, new provider <br />enrollment visits, fraud and abuse reporting, monthly accountability reports , andprivate provider report of vaccine usage. <br />I Facilitate annual renewal of the provider agreement Provider Agreements for Receipt Annually, per Annual Reimbursement for <br />for receipt of state supplied vaccine for all of State Supplied Vaccine received VFC Provider actual costs incurred, <br />healthcare providers receiving state-supplied online via the Washington Agreement Update not to exceed total <br />childhood vaccine Immunization Information System. Schedule funding consideration <br />amount. <br />Funds available for <br />this task*: <br />FFY17 AFIX <br />74310272 <br />Exhibit A, Statements of Work Page 16 of28 Contract Number CLH 18249