STATE OF VERMONT CONTRACT SUi\'lMARY AND CERTIFICATION - Form
I.
CONTRACT INFORMATION:

(3/301107)

Amendment #: 2.
Contractor Vendor No: 182150

Contract #: 10962
Agency/Department:
Agency of Human Services/Dept of Corrections
Contractor:
Prison Health Services, Inc
Contractor Address:
105 Westpark Drive, Suite 200, Brentwood, TN 37027
FederalLD or SS#:
23-2108853
1/31/2009
Starting Date:
1/2912007
Ending Date:
Summary of contract or amendment: Change of pharmacy provider
II

AA~14

FINANCIAL INFORMATION

$24364 376
I Prior Maximum:1 $ 24,364,376
I Prior Contract # (If Renewal):
Maximum Pavable:
I Cumulative amendments: I $ 0
I % Cumulative Change:
Current Amendment: $0
I
Prior # Units: #
I
# Unit ChanQe:
Maximum # Units:
$
Prior Rate:
$
Rate:
.
Source of Funds ~ Busmess UIlII(S): 03520
General Fund: 100 %
Federal Fund:
%
Other Fund:
Fund Code:
%
Dept. ID:
Dept. ID:
Dept. 10: 3480004010
III.

[gJ Ves

D

No

0%

SUITABILITY OF PERSONAL SERVICES CONTRACT

Does this contractor meet all 3 parts of the "ABC" definition of independent contractor?
(See Bulletin 3,5) Ifnot, please indicate why this work is being arranged through a contract.

D
D

Ves
Ves

[gJ
[gJ

No
No

Is agency liable for income tax withholding or FICA?
Should contractor be paid on the state payroll?

•

IV.

PUBLIC COMPETITION

The agency has taken reasonable steps to control the price of the contract and to allow qualified businesses to compete for the
work authorized by this contract. The agency has done this through:
[8J Standard bid or RFP 0 Simplified Bid
0 Sole Sourced
0 Qualification Based Selection
Other

o

V.

[8J Personal Service

0

Construction

0

TYPE OF CONTRACT

ArchitectlEngineer
VI.

0

Commodity

o Privatization* o Other

CONFLICT OF INTEREST

By signing below, I certify that no person able to control or influence award of this contract had a pecuniary interest in its award
or performance, either personally or through a member of his or her household, family, or business.
DYes

[gJ Ves

[8J No

o No

D

Ves

[8J No

D

Ves

[8J No

D

Ves

[8J No

[gJ Ves

o No

Is there an "appearance" ofa conflict of interest so that a reasonable person may conclude that this
contractor was selected for improper reasons: (If yes, explain)
VII. PRIOR APPROVALS REQUIRED OR REQUESTED

Contract must be approved by the Attorney General under 3 VSA §311 (a)(1 0)
I request the Attorney General review this contract as to form
No, Already performed by in-house AAG or counsel:
(initial)
Contract must be approved by the CIO/Commissioner of OIl; for IT hardware, software or services and
Telecommunications over $150,000
Contract must be approved by the CMO; for Marketing services over $15,000
Contracl must be approved by the Secrelary of Administration
VIII. AG

Date
Date

CYIDEPARTMENT HEAD CERTIFIC TlON' APPROVAL

xPP <wal by Attorney General
CIO (inil)

Date

CMO (initial)

Date

*Reviewed by DHR Comm. or DHR AAG

Date

Secrelary of Administration

. 1.

CHANGE # 2

AMENDMENT
It is agreed by and between the Stale of Vermont, Department of Corrections (hereafter called "State") and Prison Health

Services, Inc of Brentwood, TN, Vennont (hereafter called "Contractor") that contract #10962 dated 112912007 between
said Stale and Contractor is hereby amended as follows:

Attachment A, Chapter II -Health Care Services, Section W - Pharmaceuticals: Delete "its direct subsidiary"; replace
each usc of Secure Pharmacy Plus with Maxar National Pharmacy Services Corporation; and replace each use of SPP
with Maxar.
Except as modified by this above amendment, and any and all previous amendments 10 Ihis contract, all provisions of this
con1ract #10962 dated 1/29/2007 shall remain unchanged and in full force and effect.
The effective date of this amendment is 05/01/2007.

APPROVED AS TO FORM

AII~~omce
Date:

S/;;,,f
0)
r J
CONTRACTOR: Prison Health Service, Inc

(Please PRINT Signature)
Address: 105 Weslpark Drive, Suite 200
Brentwood, TN 37027

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State ofVemlOnt
Department of Corrections
103 South Main Street
Waterbury, \'T 05671-1001
www.doc.state.\"t.us

(fax)

Agency ofHuman Services

802-24'-2263
802-241-2565

DEPARTMENT OF CORRECTIONS

OFFICE MEMORANDUM

To:

Cynthia LaWare, Secretary
Agency of Human Services

From:

Robert Hofmann, Commissioner

Date:

May 14, 2007

Subject:

Prison Health Services, Inc - effective date of Amendment 2

I am requesting approval of a retroactive amendment for Prison Health Services,
Inc. For reasons outlined below, there was not enough time to process an amendment that
would not be retroactive.
On April 25, 2007 we received a letter from PHS dated April 23,2007 infonning
us that PHS had entered into an agreement with Maxor National Phamlacy (Maxor)
which involved the sale of certain assets of their wholly-owned subsidiary, Secure
Pharmacy Plus (SPP) to Maxor. In addition, PHS and Maxor signed a long-term service
agreement for Maxor to serve as the PHS phannaceutical provider. The effective date of
the agreement was May 1,2007.
We asked the DOC legal division for an opinion as to whether this would need a
fonnal amendment or just a memorandum of understanding and on April 30, 2007
received word thai an amendment should be done.
This amendment does not increase the contract maximum or change the delivery

of service.~~7';;1~1e;uestingyour approval of 'his request.

Approved:

~.vERMONT