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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 />o a medication log, tracking medication from order to patient receipt, disposal or return. <br />(* for example: LHJ records retention schedule: public-health-records-retention-schedule.PDP <br />See section 6) <br />• Store medications purchased using the 340B discount separately from non-340B Program <br />purchased TB medications. <br />• Conduct regular annual internal audits of inventory and patient records to maintain HRSA <br />standards and compliance regarding diversion and patient eligibility. <br />• Participate in audits by DOH or HRSA of TB -related 340B practices and provide access to <br />records demonstrating compliance with HRSA 340B regulations. <br />• Notify DOH TB Program of any medication loss or expiration including any breach of 340B <br />regulations according to DOH guidance. <br />• Notify DOH TB Program of changes regarding the LHJ's prescribing provider within 10 business <br />days. <br />o The prescribing provider must be either employed by or under contract with the LHJ, with <br />documentation required to be readily accessible. <br />■ During HRSA annual 340B registration, LHJ will complete annual recertification as a TB <br />Grantee Entity in the HRSA online 340B entity database. <br />• Ensure HRSA entity roles of Authorizing Official and Primary Contact are current and accurate <br />in the HRSAIOPA 340B online entity database and that these individuals meet the HRSA <br />requirements to fulfill these positions. <br />Ensure timely updates to any other information in the 340B database, such as LHJ physical <br />address or LHJ's name. <br />• Ensure that no 340B TB medications are given to patients Disburse 34 with Medicaid or Apple <br />Health. <br />o LHJs may use alternate TB medications provided by DOH such as those purchased using the <br />MMCAP discount program or former CDC National Stockpile TB medications. <br />■ Ensure that Medicaid is not billed for any 340B TB medications. <br />DOH TB Program Contact: Justina Novak, 'usEina.novak rr7doh.wa.,gov or 360-810-0211. <br />Signature: <br />Email: dohcon.mgmt@doh.wa.gov <br />DOH Contract CLH32635-0 Page 9 of 9 <br />July 2025 <br />