HomeMy WebLinkAbout01.01.26-12.31.29 Interlocal Agreement between State of Wa and KCPHD (TB)BOARD OF COUNTY COMMISSIONERS
COUNTY OF KITTITAS
STATE OF WASHINGTON
RESOLUTION
NO.2026-
RESOLUTION TO AUTHORIZE EXECUTION OF AN INTERLOCAL AGREEMENT
BETWEEN KITTITAS COUNTY AND THE WASHINGTON STATE DEPARTMENT
OF HEALTH
WHEREAS, RCW 39.34, the Interlocal Cooperation Act, provides the capability for public
agencies to cooperate for mutual advantage; and
WHEREAS, Kittitas County, through the Kittitas County Public Health Department (KCPHD),
is charged with the preservation, promotion, and improvement of health in the
County; and
WHEREAS, Addressing Tuberculosis by providing necessary medications in accordance with
applicable medical and legal requirements aligns with obligations of KCPHD; and
WHEREAS, the Washington State Department of Health operates a program through which
Tuberculosis medications are provided to local health departments at no cost to the
receiving entity, as detailed in the attached Interlocal Cooperation Agreement,
which is incorporated herein by this reference; and
WHEREAS, the Board of County Commissioners find that it is in the best interest of the
County, and all its citizens to enter the Interlocal Agreement.
NOW THEREFORE, BE IT RESOLVED that the Board of County Commissioners of Kittitas
County, Washington, authorizes execution of an Interlocal Agreement with the State of
Washington Department of Health.
DATED this day of _ 2026, at Ellensburg, Washington.
BOARD OF COUNTY COMMISSIONERS
KITTITAS COUNTY, WASHINGTON
Chair
Vice -Chair
Commissioner
ATTEST:
Clerk of the Board
Kittitas County Public Health
Contract/Agreement Review Form
Today's Date; 04/28/26
Fund/Department: 116-Public Health
Cont
Information
Legal Request #:
Agenda Date:
Kittitas County
Public Health
Department
Contract/Agreement Title: Interlocal Agreement between State of Wa DOH and KCPHD
Begin Date: 01/01/26 i End Date: 12/31/29
Total $ Amount: 0.00 Contract/Agreement #: CLH32635-0
Contract/Agreement Summary:
The agreement is made by and between the State of Washington Department of Health and
Kittitas County Public Health to cover TB medications used to treat active TB disease in patients
who are under or uninsured or who lack prescription coverage and are not covered by Medicaid
or Apple Health.
Kittitas County Prosecutor and Auditor Review and Comment:
APPROVED AS T&TORM:
Signature of Prdsecutor's Office 14 I Date
Signature of Auditor's OffIcA Date
Budget Information
Revenue Code(s):
Expense Code(s):
Agency is not suspended/disbarred Not Checked (reason)
Pass Through Information
Agency to Pass Through
Amount to Pass Through
Sub -Contract Approved Date:
Expense Code:
ADMIN Version: 0 l supersedes: 0 1 Date Adopted: 12/01/2024 Modified By: Katie Odiaga Approval By: Chelsey Loeffers
6/12/26, 12:56 PM
SAM.gov
Entity Information
HEALTH, WAS H I N C TO N Active Registration
STATE DEPARTMENT OF
Unique Entity ID CAGE/NCAGE
C16SP2HBR123 1 FSD1
Physical Address
101 Israel RD SE
Tumwater, Washington
98501-5570, United States
Purpose of Registration
All Awards
Version
Current Record
BUSINESS INFORMATION
Doing Business As URL
(blank)
doh.wa.gov
Division Name
Division Number
(blank)
(blank)
Congressional
State/Country of
District
Incorporation
Washington 10
(blank), (blank)
Owner CAGE Legal Business
Name
Immediate (blank)(blank)
Owner
Expiration Date
Mailing Address
101 Israel RD SE
Tumwater, Washington
98501-5570, United States
Registration Dates
Activation Date
Sep 3, 2025
Submission
Date
Sep 3, 2025
Initial Registration
Date
Apr 2, 2002
Sep 3, 2026
Highest Level (blank)(blank)
Owner
https://sam.gov/entities/view/Cl6SP2HBR123/coreData?status=Active&emrKeyValue=2164854-1755894257626050®ld=16317582
1/2
6/12/26, 12:56 PM SAM.gov
Entity Dates
Entity Start
Date
Jul 1, 1989
Fiscal Year End
Close Date
Jun 30
Executive Compensation
Registrants in the System for Award Management (SAM) respond to the Executive Compensation
questions in accordance with Section 6202 of P.L. 110-252, amending the Federal Funding
Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is
sent to USAspending.gov for display in association with an eligible award. Maintaining an active
registration in SAM demonstrates the registrant responded to the questions.
SAM SEARCH AUTHORIZATION
I authorize my entity's non -sensitive information to be displayed in SAM public search results.
Yes
ENTITY TYPES
Business Types
Entity Structure U.S. Government
Entity
Entity Type US State Government
Profit Structure (blank)
Organization (blank)
Factors
Socio-Economic Types
Check the registrant's Reps & Certs, if
present, under FAR 52.212-3 or FAR 52.219-1
to determine if the entity is an SBA -certified
HUBZone small business concern. Additional
small business information may be found in
the SBA's Dynamic Small Business Search if
the entity completed the SBA supplemental
pages during registration.
https://sam.gov/entities/view/C16SP2HBR123/core Data? status=Active&emrKeyValue=2164854-1755894257626050®ld=16317582 2/2
Washington State Department of CONTRACT NUMBER: SUBRECIPIENT *
HEALTH CLH32635-0 ❑YES ®NO
INTERLOCAL AGREEMENT
Between
STATE OF WASHINGTON
DEPARTMENT OF HEALTH
And
Kittitas County Public Health
THIS AGREEMENT is made by and between the State of Washington Department of Health, hereinafter
referred to as DOH, and Kittitas County Public Health, hereinafter referred to as LHJ pursuant to the
authority granted by Chapter 39.34 RCW.
PURPOSE: The purpose is to cover TB medications used to treat active TB disease in patients who are
under- or uninsured or who lack prescription coverage and are not covered by Medicaid or Apple Health.
THEREFORE, IT IS MUTUALLY AGREED THAT:
STATEMENT OF WORK AND BUDGET: The LHJ shall furnish the necessary personnel, equipment,
material and/or services and otherwise do all things necessary for or incidental to the performance of the
work set forth in Exhibit A, attached hereto and incorporated herein.
PERIOD OF PERFORMANCE: Subject to its other provisions, the period of performance of this
Agreement shall commence on January 1, 2026, and be completed on December 31, 2029, unless
terminated sooner as provided herein. Any work done outside of the period of performance shall be
provided at no cost to DOH.
FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA): If federal
funds are included in this contract as indicated below, this contract requires compliance with the Federal
Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the
Transparency Act is to make information available online so the public can see how federal funds are spent.
To comply with the act and be eligible to enter into this contract, your organization must have a Unique
Entity Identifier (UEI) number. A UEI number provides a method to verify data about your organization.
If you do not already have one, you may receive a UEI number free of charge by contacting System for
Award Management (SAM) at SAM.GOV.
Information about your organization and this contract will be made available on www.USASpending.Vy
by DOH as required by P.L. 109-282.
PAYMENT: Compensation for the work provided in accordance with this Agreement has been established
under the terms of RCW 39.34.130. The parties have estimated that the cost of accomplishing the work
herein will not exceed $0.00 in accordance with Exhibit A, attached hereto and incorporated herein.
Compensation incudes but is not limited to all taxes, fees, surcharges, etc. Payment will not exceed this
amount without a prior written amendment. DOH will authorize payment only upon satisfactory completion
and acceptance of deliverables and for allowable costs as outlined in the statement of work and/or budget.
DOH Contract CLH32635-0 Page I of 9
July 2025
INVOICES AND PAYMENT: LHJ will submit invoices to the DOH Contract Manager for all amounts
to be paid within 30 days of the month of service, or the submission date of deliverables with an associated
cost, as specified in the Statement of Work (SOW). Refer to the SOW, Exhibit A, for invoice due dates on
any budget/funding period(s) that end during the contract period of performance. DOH must receive correct
and complete FINAL invoices no later than 45 days after the contract expiration date. Invoices must
reference the contract number and provide detailed information as required. All invoices must be approved
by DOH prior to payment; approval will not be unreasonably withheld. DOH will authorize payment only
upon satisfactory completion and acceptance of deliverables and for allowable costs as outlined in the
statement of work and/or budget. DOH will return all incorrect or incomplete invoices and will not pay for
services that occur outside the period of performance. The LHJ will not invoice for services if they are
entitled to payment, have been, or will be paid, by any other source for that service.
DOH will issue payment within 30 days of receiving a correct and complete invoice and approving the
deliverable(s). Late invoices will be paid at the discretion of DOH and are contingent upon the availability
of funds. Failure to submit a properly completed IRS form W-9 may result in delayed payments.
AGREEMENT ALTERATIONS AND AMENDMENTS: This Agreement may be amended by mutual
agreement of the parties. Such amendments shall not be binding unless they are in writing and signed by
personnel authorized to bind each of the parties.
ASSIGNMENT: The work to be provided under this Agreement, and any claim arising thereunder, is not
assignable or delegable by either party in whole or in part, without the express prior written consent of the
other party, which consent shall not be unreasonably withheld.
CONFIDENTIALITY/SAFEGUARDING OF INFORMATION: The use or disclosure by any party of
any information concerning a client obtained in providing service under this Agreement shall be subject to
Chapter 42.56 RCW and Chapter 70.02 RCW, as well as any other applicable Federal and State statutes
and regulations.
Any unauthorized access or use of confidential information must be reported to the DOH Chief Information
Security Officer at securi doh.wa. ov. The notification must be made in the most expedient time
possible (usually within one business day) and without unreasonable delay, consistent with the legitimate
needs of law enforcement, or any measures necessary to determine the scope of the breach and restore the
reasonable integrity of the data system.
CONTRACT MANAGEMENT: The contract manager for each of the parties shall be responsible for and
shall be the contact person for all communications and billings regarding the performance of this agreement.
The Contract Manager for DOH is: The Contract Manager for the LHJ is:
Name:
Justina Novak
Disease Control and Health
Office:
Statistics
Agency:
Department of Health
Address:
PO Box 47837
City, State,
Zip:
Olympia, WA 98504-7837
Phone:
260 236-3725
DOH Contract CLH32635-0
July 2025
Name: Kate Johnson
Email: —kate.johnson@co.kittitas.wa.us
Agency: Kittitas County Public Health
Address: 507 N. Nanum Street, Suite 102
City, State,
Zip: Ellensburg,WA 98926-2886
Phone: 509-962-7634
Page 2 of 9
DISPUTES: In the event that a dispute arises under this Agreement, it shall be determined by a Dispute
Board in the following manner: Each party to this agreement shall appoint one member to the Dispute
Board. The members so appointed shall jointly appoint an additional member to the Dispute Board. The
Dispute Board shall review the facts, Agreement terms and applicable statutes and rules and make a
determination of the dispute. The determination of the Dispute Board shall be final and binding on the
parties hereto. As an alternative to this process, either of the parties may request intervention by the
Governor, as provided by RCW 43.17.330, in which event the Governor's process will control.
GOVERNANCE: This Agreement is entered into pursuant to and under the authority granted by the laws
of the State of Washington and any applicable federal laws. The provisions of this Agreement shall be
construed to conform to those laws.
In the event of an inconsistency in the terms of this Agreement, or between its terms and any applicable
statute or rule, the inconsistency shall be resolved by giving precedence in the following order:
A. Federal statutes and regulations
B. State statutes and regulations
C. Agreement amendments
D. The Agreement (in this order)
1. Primary document (document that includes the signature page)
2. Statement of Work (Exhibit A)
INDEPENDENT CAPACITY: The employees or agents of each party who are engaged in the
performance of this Agreement shall continue to be employees or agents of that party and shall not be
considered for any purpose to be employees or agents of the other party.
NONDISCRIMINATION:
A. Nondiscrimination Requirement. During the term of this Contract, LHJ, including any
subcontractor, shall not discriminate on the bases enumerated at RCW49.60.530(3). In
addition, Contractor, including any subcontractor, shall give written notice of this
nondiscrimination requirement to any labor organizations with which LHJ, or subcontractor,
has a collective bargaining or other agreement.
A. Obli atian to Coo erate. LHJ, including any subcontractor, shall cooperate and comply with
any Washington state agency investigation regarding any allegation that LHJ, including any
subcontractor, has engaged in discrimination prohibited by this Contract pursuant to
RCW49.60.530(3).
B. Default. Notwithstanding any provision to the contrary, DOH may suspend LHJ, including any
subcontractor, upon notice of a failure to participate and cooperate with any state agency
investigation into alleged discrimination prohibited by this Contract, pursuant to
RCW49.60.530(3). Any such suspension will remain in place until DOH receives notification
that LHJ, including any subcontractor, is cooperating with the investigating state agency. In
the event LHJ, or subcontractor, is determined to have engaged in discrimination identified at
RCW49.60.530(3), DOH may terminate this Contract in whole or in part, and LHJ,
subcontractor, or both, may be referred for debarment as provided in RCW 39.26.200. The LHJ
or subcontractor may be given a reasonable time in which to cure this noncompliance, including
implementing conditions consistent with any court -ordered injunctive relief or settlement
agreement.
C. Remedies for Breach. Notwithstanding any provision to the contrary, in the event of Contract
termination or suspension for engaging in discrimination, LHJ, subcontractor, or both, shall be
DOH Contract CLH32635-0 Page 3 of 9
July 2025
liable for contract damages as authorized by law including, but not limited to, any cost
difference between the original contract and the replacement or cover contract and all
administrative costs directly related to the replacement contract, which damages are distinct
from any penalties imposed under Chapter 49.60, RCW. DOH shall have the right to deduct
from any monies due to LHJ or subcontractor, or that thereafter become due, an amount for
damages LHJ or subcontractor will owe DOH for default under this provision thereafter
become due, an amount for damages LHJ or subcontractor will owe DOH for default under this
provision.
PRIVACY: Personal information collected, used or acquired in connection with this Agreement shall be
used solely for the purposes of this Agreement. LHJ and its subcontractors agree not to release, divulge,
publish, transfer, sell or otherwise make known to unauthorized persons personal information without the
express written consent of the agency or as provided by law. LHJ agrees to implement physical, electronic
and managerial safeguards to prevent unauthorized access to personal information.
DOH reserves the right to monitor, audit or investigate the use of personal information collected, used or
acquired by the LHJ through this Agreement. The monitoring, auditing, or investigating may include but is
not limited to "salting" by DOH. LHJ shall certify the return or destruction of all personal information upon
expiration of this Agreement. Salting is the act of placing a record containing unique but false information
in a database that can be used later to identify inappropriate disclosure of data contained in the database.
Any breach of this provision may result in termination of the Agreement and the demand for return of all
personal information. The LHJ agrees to indemnify and hold harmless DOH for any damages related to the
LHJ's unauthorized use of personal information.
RECORDS MAINTENANCE: The parties to this Agreement shall each maintain books, records,
documents and other evidence which sufficiently and properly reflect all direct and indirect costs expended
by either party in the performance of the services described herein. These records shall be subject to
inspection, review or audit by personnel of both parties, other personnel duly authorized by either party,
the Office of the State Auditor, and federal officials so authorized by law. All books, records, documents,
and other material relevant to this Agreement will be retained for six years after expiration and the Office
of the State Auditor, federal auditors, and any persons duly authorized by the parties shall have full access
and the right to examine any of these materials during this period.
Records and other documents, in any medium, furnished by one parry to this Agreement to the other party,
will remain the property of the furnishing party, unless otherwise agreed. The receiving party will not
disclose or make available this material to any third parties without first giving notice to the furnishing
party and giving it a reasonable opportunity to respond. Each party will utilize reasonable security
procedures and protections to assure that records and documents provided by the other party are not
erroneously disclosed to third parties.
RIGHTS IN DATA: Unless otherwise provided, data, which originates from this Agreement shall be
"works for hire" as defined by the U.S. Copyright Act of 1976 and shall be owned by DOH. Data shall
include, but not be limited to, reports, documents, pamphlets, advertisements, books magazines, surveys,
studies, computer programs, films, tapes, and/or sound reproductions. Ownership includes the right to
copyright, patent, register, and the ability to transfer these rights.
SECURITY OF INFORMATION — Unless otherwise specifically authorized by the DOH Chief
Information Security Officer, LHJ receiving confidential information under this contract assures that:
Encryption is selected and applied using industry standard algorithms validated by the
National Institute of Standards and Technology (MIST) Cryptographic Algorithm Validation
DOH Contract CLH32635-0 Page 4 of 9
July 2025
Program against all information stored locally and off -site. Information must be encrypted
both in -transit and at rest and applied in such a way that it renders data unusable to anyone
but authorized personnel, and the confidential process, encryption key or other means to
decipher the information is protected from unauthorized access.
• It is compliant with the applicable provisions of the Washington State Office of Washington
Technology Solutions (WaTech) policy SEC-01 through SEC-13, Securing Information
Technology Assets, available at: htt s://ocio.wa.vov/)olic /securinU-information-techno ooav-
assets.
• It will provide DOH copies of its IT security policies, practices and procedures upon the
request of the DOH Chief Information Security Officer.
• DOH may at any time conduct an audit of the LHF s security practices and/or infrastructure to
assure compliance with the security requirements of this contract.
• It has implemented physical, electronic and administrative safeguards that are consistent with
WaTech security standard SEC-01 through SEC-13 and ISB IT guidelines to prevent
unauthorized access, use, modification or disclosure of DOH Confidential Information in any
form.
This includes, but is not limited to, restricting access to specifically authorized individuals and
services through the use of:
o Documented access authorization and change control procedures;
o Card key systems that restrict, monitor and log access;
o Locked racks for the storage of servers that contain Confidential Information or use
AES encryption (key lengths of 256 bits or greater) to protect confidential data at
rest, standard algorithms validated by the National Institute of Standards and
Technology (NIST) Cryptographic Algorithm Validation Program (CMVP);
o Documented patch management practices that assure all network systems are running
critical security updates within 6 days of release when the exploit is in the wild, and
within 30 days of release for all others;
o Documented anti -virus strategies that assure all systems are running the most current
anti -virus signatures within 1 day of release;
o Complex passwords that are systematically enforced and password expiration not to
exceed 120 days, dependent user authentication types as defined in WaTech security
standards;
o Strong multi -factor authentication mechanisms that assure the identity of individuals
who access Confidential Information;
o Account lock -out after 5 failed authentication attempts for a minimum of 15 minutes,
or for Confidential Information, until administrator reset;
o AES encryption (using key lengths 128 bits or greater) session for all data
transmissions, standard algorithms validated by NIST CMVP;
o Firewall rules and network address translation that isolate database servers from web
servers and public networks;
o Regular review of firewall rules and configurations to assure compliance with
authorization and change control procedures;
o Log management and intrusion detection/prevention systems;
o A documented and tested incident response plan
Any breach of this clause may result in termination of the contract and the demand for return of all personal
information.
DOH Contract CLH32635-0 Page 5 of 9
July 2025
SEVERABILITY: If any provision of this Agreement or any provision of any document incorporated by
reference shall be held invalid, such invalidity shall not affect the other provisions of this Agreement which
can be given effect without the invalid provision, if such remainder conforms to the requirements of
applicable law and the fundamental purpose of this Agreement, and to this end the provisions of this
Agreement are declared to be severable.
SUBCONTRACTING: Neither the LHJ, nor any subcontractors, shall enter into subcontracts for any of
the work contemplated under this agreement without prior written approval of DOH. In no event shall the
existence of the sub operate to release or reduce the liability of the LHJ to DOH for any breach in the
performance of the LHFs duties. This clause does not include contracts of employment between the LHJ
and personnel assigned to work under this Agreement.
Additionally, the LHJ is responsible for ensuring that all terms, conditions, assurances and certifications set
forth in this Agreement are carried forward to any subcontracts. LHJ and its subcontractors agree not to
release, divulge, publish, transfer, sell or otherwise make known to unauthorized persons personal
information without the express written consent of DOH or as provided by law.
If, at any time during the progress of the work, DOH determines in its sole judgment that any subcontractor
is incompetent, DOH shall notify the Contractor, and the LHJ shall take immediate steps to terminate the
subcontractor's involvement in the work. The rejection or approval by DOH of any subcontractor or the
termination of a subcontractor shall not relieve the LHJ of any of its responsibilities under the Agreement,
nor be the basis for additional charges to DOH.
SUSPENSION OF PERFORMANCE AND RESUMPTION OF PERFORMANCE: In the event
contract funding from State, Federal, or other sources is withdrawn, reduced, or limited in any way after
the effective date of this Agreement and prior to normal completion, DOH may give notice to LHJ to
suspend performance as an alternative to termination. DOH may elect to give written notice to LHJ to
suspend performance when DOH determines that there is a reasonable likelihood that the funding
insufficiency may be resolved in a timeframe that would allow performance to be resumed prior to the end
date of this Agreement. Notice may include notice by facsimile or email to Contractor's representative.
LHJ shall suspend performance on the date stated in the written notice to suspend. During the period of
suspension of performance each party may inform the other of any conditions that may reasonably affect
the potential for resumption of performance.
When DOH determines that the funding insufficiency is resolved, DOH may give LHJ written notice to
resume performance and a proposed date to resume performance. Upon receipt of written notice to resume
performance, LHJ will give written notice to DOH as to whether it can resume performance, and, if so, the
date upon which it agrees to resume performance. If LHJ gives notice to DOH that it cannot resume
performance, the parties agree that the Agreement will be terminated retroactive to the original date of
termination. If the date LHJ gives notice it can resume performance is not acceptable to DOH, the parties
agree to discuss an alternative acceptable date. If an alternative date is not acceptable to DOH, the parties
agree that the Agreement will be terminated retroactive to the original date of termination.
TERMINATION: Either party may terminate this Agreement upon 30 days prior written notification to
the other party. If this Agreement is so terminated, the parties shall be liable only for performance rendered
or costs incurred in accordance with the terms of this Agreement prior to the effective date of termination.
TERMINATION FOR CAUSE: If for any cause, either party does not fulfill in a timely and proper
manner its obligations under this Agreement, or if either party violates any of these terms and conditions,
the aggrieved party will give the other party written notice of such failure or violation. The responsible
party will be given the opportunity to correct the violation or failure within 15 working days. If the failure
DOH Contract CLH32635-0 Page 6 of 9
July 2025
or violation is not corrected, this Agreement may be terminated immediately by written notice of the
aggrieved party to the other.
WAIVER: A failure by either party to exercise its rights under this Agreement shall not preclude that party
from subsequent exercise of such rights and shall not constitute a waiver of any other rights under this
Agreement unless stated to be such in a writing signed by an authorized representative of the parry and
attached to the original Agreement.
ALL WRITINGS CONTAINED HEREIN: This Agreement contains all the terms and conditions agreed
upon by the parties. No other understandings, oral or otherwise, regarding the subject matter of this
Agreement shall be deemed to exist or to bind any of the parties hereto.
IN WITNESS WHEREOF, the parties have executed this Agreement.
LHJ SIGNATURE
DATE
PRINT OR TYPE NAME
TITLE
DOH CONTRACTING OFFICER SIGNATURE
DATE
This contract has been approved as to form by the attorney general.
DOH Contract CLH32635-0 Page 7 of 9
July 2025
EXHIBIT A
STATEMENT OF WORK
Washington State TB Program
Kittitas County Public Health
DOH Contract Number CLH32635-0
PERIOD OF AGREEMENT: This agreement will commence on January 1, 2026, and will be effective
until December 31, 2029, or until the Parties give each other written notice to terminate the agreement.
This medication program is ongoing. After the initial three-year period of performance, this agreement will be
on a five-year review/renewal cycle but updated/amended as needed based on DOH and/or Health Resources
and Services Administration Office of Pharmacy Affairs (HRSA) 340B changing requirements.
PURPOSE AND SCOPE: The intent of this agreement is to:
• define responsibilities of Parties participating in the HRSA 340B Pricing Program under the DOH
TB Program entity.
• ensure appropriate use of state taxpayer funds used to acquire tuberculosis (TB) medications.
• maintain compliance with HRSA requirements for the 340B Pricing Program entities and those
participating under DOH TB Program entity as part of grantee combined purchasing and
distribution model for TB medications.
• support compliance with HRSA 340B requirements of covered entities.
The scope of this agreement covers TB medications used to treat active TB disease in patients who are
under- or uninsured or who lack prescription coverage and are not covered by Medicaid or Apple Health.
HRSA entities, including LHJs, are expected to be the payer of last resort."
o Case -by -case exceptions may be made for Latent TB Infection (LTBI) patients who are likely to
progress to TB disease or as announced by DOH.
Being the payer of last resort, public health agencies (local, state, or federal) should use their funding only
after all reasonable payment sources have been exhausted.
DOH TB PROGRAM RESPONSIBILITIES:
• Provide without charge TB medications as listed on their current formulary to Local Health
Jurisdictions (LHJs). The fonnulary is posted on SharePoint.
o DOH will cover the cost of the medication, shipping, and pharmacy.
• Annually provide information (example: CDC Notice of Award Number) needed for the LHJ to
recertify with HRSA as a federal grantee entity in the 340B program.
LOCAL HEALTH RESPONSIBILITIES: Local Health Jurisdictions will:
■ Maintain auditable records for the duration identified by required applicable records retention
schedules*. These records to include but not limited to are:
o a separate medication inventory tracking system with records tied to patients receiving the
medication.
DOH Contract CLH32635-0 Page 8 of 9
July 2025
EXHIBIT A
STATEMENT OF WORK
Washington State TB Program
Kittitas County Public Health
DOH Contract Number CLH32635-0
o a medication log, tracking medication from order to patient receipt, disposal or return.
(* for example: LHJ records retention schedule: public-health-records-retention-schedule.PDP
See section 6)
• Store medications purchased using the 340B discount separately from non-340B Program
purchased TB medications.
• Conduct regular annual internal audits of inventory and patient records to maintain HRSA
standards and compliance regarding diversion and patient eligibility.
• Participate in audits by DOH or HRSA of TB -related 340B practices and provide access to
records demonstrating compliance with HRSA 340B regulations.
• Notify DOH TB Program of any medication loss or expiration including any breach of 340B
regulations according to DOH guidance.
• Notify DOH TB Program of changes regarding the LHJ's prescribing provider within 10 business
days.
o The prescribing provider must be either employed by or under contract with the LHJ, with
documentation required to be readily accessible.
■ During HRSA annual 340B registration, LHJ will complete annual recertification as a TB
Grantee Entity in the HRSA online 340B entity database.
• Ensure HRSA entity roles of Authorizing Official and Primary Contact are current and accurate
in the HRSAIOPA 340B online entity database and that these individuals meet the HRSA
requirements to fulfill these positions.
Ensure timely updates to any other information in the 340B database, such as LHJ physical
address or LHJ's name.
• Ensure that no 340B TB medications are given to patients Disburse 34 with Medicaid or Apple
Health.
o LHJs may use alternate TB medications provided by DOH such as those purchased using the
MMCAP discount program or former CDC National Stockpile TB medications.
■ Ensure that Medicaid is not billed for any 340B TB medications.
DOH TB Program Contact: Justina Novak, 'usEina.novak rr7doh.wa.,gov or 360-810-0211.
Signature:
Email: dohcon.mgmt@doh.wa.gov
DOH Contract CLH32635-0 Page 9 of 9
July 2025