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STATEMENT OF WORK <br />Washington State TB Program <br />Kittitas CountY Public Health <br />DOH Contract Number CLH32635-0 <br />EXHIBIT A <br />a <br />o a medication log, tracking medication from order to patient receipt, disposal or return' <br />(* for example: LHJ recordl retention schedule: public-health-records-retention-schedule'PDF <br />See section 6) <br />Store medications purchased using the 3408 discount separately from non-340B Program <br />purchased TB medications, <br />conduct regular annual intemal audits of inventory and patient-records to maintain HRSA <br />standards aid compliance regarding diversion and patient eligibility. <br />Participate in audits by DoH or HRSA of TB-related 3408 practices and provide access to <br />records demonstrating compliance with HRSA 3408 regulations' <br />a <br />a <br />. Notify DoH TB program of any medication loss or expiration including any breach of 3408 <br />regulations according to DOH guidance' <br />. Notify DoH TB program of changes regarding the LHJ's prescribing provider within l0 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 3408 registration, LHJ will complete annual recertification as a TB <br />Grantee Entity in the HRSA online 3408 entity database' <br />. Ensure HRSA entity roles of Authorizing Official and Primary Contact are current and accurate <br />in the HRSA/OPA 3408 online entitv daltabase and that these individuals meet the HRSA <br />requirements to fulfill these positions' <br />r Ensure timely updates to any other information in the 3408 database, such as LHJ physical <br />address or LHJ's name. <br />r Ensure that no 3408 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 aiscount program or former CDC National Stockpile TB medications' <br />rEnsurethatMedicaidisnotbilledforany3408TBmedications' <br />DOH TB Program contact: JustinaNovak, justina.novak@doh'wa'gov or 360-810-0211' <br />Signature: <br />Email: dohcon.mgmt@doh.wa.gov <br />DOH Contract CLH32635-0 <br />July 2025 <br />Page 9 of9