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EXHIBIT A <br />STATEMENT OF WORK <br />Washington State TB Program <br />Kittitas County Public Health <br />DOH Contract Number CLH32635-0 <br />PERIOD OF AGREEMENT: This agreement will commence on January 1, 2026, and will be effective <br />until December 31, 2029, or until the Parties give each other written notice to terminate the agreement. <br />This medication program is ongoing. After the initial three-year period of performance, this agreement will be <br />on a five-year review/renewal cycle but updated/amended as needed based on DOH and/or Health Resources <br />and Services Administration Office of Pharmacy Affairs (HRSA) 340B changing requirements. <br />PURPOSE AND SCOPE: The intent of this agreement is to: <br />• define responsibilities of Parties participating in the HRSA 340B Pricing Program under the DOH <br />TB Program entity. <br />• ensure appropriate use of state taxpayer funds used to acquire tuberculosis (TB) medications. <br />• maintain compliance with HRSA requirements for the 340B Pricing Program entities and those <br />participating under DOH TB Program entity as part of grantee combined purchasing and <br />distribution model for TB medications. <br />• support compliance with HRSA 340B requirements of covered entities. <br />The scope of this agreement covers TB medications used to treat active TB disease in patients who are <br />under- or uninsured or who lack prescription coverage and are not covered by Medicaid or Apple Health. <br />HRSA entities, including LHJs, are expected to be the payer of last resort." <br />o Case -by -case exceptions may be made for Latent TB Infection (LTBI) patients who are likely to <br />progress to TB disease or as announced by DOH. <br />Being the payer of last resort, public health agencies (local, state, or federal) should use their funding only <br />after all reasonable payment sources have been exhausted. <br />DOH TB PROGRAM RESPONSIBILITIES: <br />• Provide without charge TB medications as listed on their current formulary to Local Health <br />Jurisdictions (LHJs). The fonnulary is posted on SharePoint. <br />o DOH will cover the cost of the medication, shipping, and pharmacy. <br />• Annually provide information (example: CDC Notice of Award Number) needed for the LHJ to <br />recertify with HRSA as a federal grantee entity in the 340B program. <br />LOCAL HEALTH RESPONSIBILITIES: Local Health Jurisdictions will: <br />■ Maintain auditable records for the duration identified by required applicable records retention <br />schedules*. These records to include but not limited to are: <br />o a separate medication inventory tracking system with records tied to patients receiving the <br />medication. <br />DOH Contract CLH32635-0 Page 8 of 9 <br />July 2025 <br />