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Task <br />Task/Activity/Description *May Support PHAB Due Datefl'ime Payment <br />Number Standards/Measures Deliverables/Outcomes Frame Information and/or <br />Amount <br />*See Restrictions on <br />Funds below <br />2 Enroll new providers. Conduct an enrollment site Provider Agreement for Receipt of Within ten (10) days Reimbursement for <br />visit to all new providers, and gather infonnation State Supplied Vaccine with after the date of the actual costs incurred, <br />needed to complete Program enrolhnent original signature -DOH 348-002 provider enrollment not to exceed total <br />(NOTE: a photocopy will not be visit funding consideration <br />accepted) amount. <br />Funds available for <br />this task*: <br />FFY17 AFIX <br />743I0272 - <br />* See Restrictions on <br />Funds below <br />3 Use and facilitate provider use of the Washington Electronic submission of provider Based on provider Reimbursement for <br />Immunization Information System to place and vaccine orders via the Washington order schedules actual costs incurred, <br />approve provider vaccine orders. Monitor provider Immunization Information System not to exceed total <br />orders for appropriateness (including: accuracy of funding consideration <br />shipping infonnation, order frequency, timing, amount. <br />quantity and type) and approve vaccine order <br />online after assuring the appropriateness of the Funds available for <br />order. this task": <br />FFYl 7 VFC Ops <br />74310271 <br />FFY17 3170ps <br />74310270 <br />*See Restrictions on <br />Funds below <br />·4 Monitor and assure electronic or paper submission a) Monthly Vaccine a) By the 25th of Reimbursement for <br />of vaccine accountability reports for compliance Accountability Report each month actual costs incurred, <br />with Provider Agreement related to vaccine (OOH 348-006 not to exceed total <br />management ( ordering, inventory management, funding consideration <br />reconciliation, compliance with storage and b) Report of Vaccine Storage b) Within seven (7) amount. <br />handling, and reporting of all vaccine incidents and Incidents (DOH 348-154) days of the <br />returns). complete with reason and incident Funds available for <br />corrective action as needed. this task*: <br />Exhibit A, Statements of Work Page 17 of28 Contract Number CLHl 8249