Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Title: Regional VP of Operations – Midwest Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD STEVEN XXXXXXXXXX Signature: Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX 00 Xxxxxxxxx Xxxxxx Xxxx Title: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxCold Xxxxxx Xxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 NY 181989 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30Jan 3, 2021 Date: 12/2/2021 2022 Date:1/4/2022 | 1:22 PM CST 7:53 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature1/4/2022 | 7:53 AM PST Date: Signature: Print Name: _Richard X Xxxxxxx Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnxRPh, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX MS Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxx Xx Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _OH 00 000000 NY 224860 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30Jan 3, 2021 Date: 12/2/2021 | 1:22 PM CST 2022 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: :Xxxxx Xxxxxxxx D.O. Signature: Print Name: _Richard X Xxxxx, MD Jason Torrente D.O. Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX 4318 Route 130N Title: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 25MB07308300 City/State/Zip: Xxxxxx, XX 00000 Phone#: 000-000-0000 Date: _Dec 27, 2021 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 1/3/2022 | 1:22 PM CST 11:14 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Charles Moehs Signature: Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX 200 Xxxxxx St Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, Xxxxxxxxx XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 NY 104750 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30Jan 4, 2021 Date: 12/2/2021 2022 Date:1/4/2022 | 1:22 PM CST 7:53 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, H Xxxxxxx Xxxx MD Signature: Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 000 Xxxxxxxx Xxxxx Xx XX Title: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 000.0000000 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST 11:37 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Vermont Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Vermont Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Vermont Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Vermont Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Vermont Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Vermont Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Vermont Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Vermont Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Vermont Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Vermont Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Vermont Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Vermont Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Vermont Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Vermont Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-28 A-26 Exhibit A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Vermont
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Authorizing Physician Signature: Xxxxxxx X XxxxxX. Xxxxxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Michael Stanford Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxxxx, xRxPxh LaTonage Xxxxxx RPh Address: _0000 Xxxxx Xx XX Xxxxxxxx Xxxx Title: Regional VP of Operations – Midwest South Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 AL 25447 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 1/5/22 Date: 12/2/2021 11/19/2021 | 1:22 2:31 PM CST PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – - Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) )– Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – - Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) )– Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – - Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – - Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 A-27 Japanese Encephalitis – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Alabama5 Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx 5 Per a telephone conversation with Xxxxx, a nurse with the Immunization Division (1-800-469-4599) Alabama Department of Public Health Immunization Division, Alabama will not allow pharmacists or pharmacies to hold the Yellow Fever stamp. (December 11, 2013) Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X XxxxxAmr Elebiary, MD Print Name: JxoxyxxHxoxlmxxaxnxPharm.D., xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX MBA Title: Regional VP of Operations – Midwest West Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: XxxxxxRenton, XX 00000 WA 98057 Phone#: (000) 000-0000 Date: 11/22/2021 | 11:43 AM PST Signature: Print Name: _Nov 30Rushdi Alul Address: _2233 Xxxx Xxxxxxxx Xxxxxx Xxxx/Xxxxx/Xxx: _Xxxxxxx, 2021 XX 00000 Medical License#: _000.000000 Phone#: _000-000-0000 x0000 Date: 12/2/2021 | 1:22 PM CST _1/10/22 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Only physicians may administer yellow fever vaccine.14 Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Authorizing Practitioner Signature: Signature: Xxxxxx X Xxxxx MD Signature: Print Name: _Richard X Xxxxx, MD Robert Xxxxx Print Name: JxoxyxxHxoxlmxxaxnxAmr Elebiary, xRxPxh LaTonage Xxxxxx Pharm.D., MBA Address: _0000 Xxxxx Xx XX 82 Chimney Rock Rd Title: Regional VP of Operations – Midwest Division CityXxxx Xxxxxxxx Xxxx/StateXxxxx/ZipXxx: _XxxxxxxxxxxxXxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 MN 43830 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 1/5/22 Date: 12/2/2021 11/23/2021 | 1:22 PM CST 8:10 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Protocol Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. 12/14/2021 | 1:55 PM PST Date: Signature: Print Name: Xxxxxxx Xxxxxxx, RPh Title: Regional VP of Operations – South Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxxxxx Xxxxxx, MD, PhD Address: _2000 Xxx Xxxxxxx City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _60215 Phone#: _000-000-0000 Date: _Dec 14, 2021 Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Title: Regional VP of Operations – Midwest Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Georgia Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Georgia Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Georgia Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Georgia Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Georgia Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-32 A-27 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-28 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit X-00 XXXXX-00 Vaccines Moderna: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/moderna/downloads/standing-orders.pdf Pfizer-BioNTech: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/pfizer/downloads/standing-orders.pdf Xxxxxxx, Inc (Xxxxxxx & Xxxxxxx): xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/xxxxxxx/downloads/Xxxxxxx-Standing-Orders.pdf Attachment 1: Pharmacist Affidavit to Qualifications AFFIDAVIT OF STATE OF GEORGIA COUNTY OF Personally appeared before me, the undersigned officer who is duly authorized by law to administer oaths, , who, after first being sworn, states the following of (his/her) own personal knowledge:
Appears in 1 contract
Samples: Vaccine Protocol Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Authorizing Physician Signature: Signature: Print Name: _Richard X Xxxxx, MD Omolara Otaigbe Signature: Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxxxx, xRxPxh LaTonage Xxxxxx RPh Address: _0000 Xxxxx Xx XX Xxxxxxx 00, Xxx X Title: Regional VP of Operations – Midwest South Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 MS 17878 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 1/5/22 Date: 12/2/2021 11/29/2021 | 1:22 PM CST 7:16 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-28 A-26 Exhibit A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Mississippi Pharmacists are not permitted to administer Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature11/22/2021 | 12:12 PM PST Date: Signature: Print Name: _Richard X XxxxxXxxxxxx Xxxxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX RPh Title: Regional VP of Operations – Midwest South Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Print Name: _Xxxxx Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _OH 00 000000 MO 0000000000 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date1/5/22 Xxxxx Xxxxxxxx Signature: 12/2/2021 | 1:22 PM CST Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Missouri Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Missouri Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Missouri Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature11/22/2021 | 12:12 PM PST Date: Signature: Print Name: _Richard X XxxxxXxxxxxx Xxxxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX RPh Title: Regional VP of Operations – Midwest South Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Print Name: _David Xxxxxxxx Address: _4219 Laclede Ave City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _OH 00 000000 MO 0000000000 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date1/5/22 Xxxxx Xxxxxxxx Signature: 12/2/2021 | 1:22 PM CST Exhibit A: Protocols Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Missouri Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Missouri Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Missouri Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Missouri Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Missouri Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard Xxxxxxx X Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Title: Regional VP of Operations – Midwest Division City/State/Zip: _XxxxxxxxxxxxPickerington, XX 00000 OH 43147 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: XxxxxxRenton, XX 00000 WA 98057 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Authorizing Physician Signature: Signature: Print Name: _Richard X Xxxxx, MD Martin X. Xxxxxx Signature: Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxxxx, xRxPxh LaTonage Xxxxxx RPh Address: _0000 Xxxxx Xx XX Xxxx Xxxxxx Title: Regional VP of Operations – Midwest South Division City/State/Zip: _XxxxxxxxxxxxXxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 TN 53162 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST 10:28 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Yellow Fever stamps are not provided to pharmacists or pharmacies Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Xxxxxxx Xxxxxxx MD Signature: Print Name: _Richard X Xxxxx, William Gossman MD Print Name: JxoxyxxHxoxlmxxaxnxXxx Xxxxxxxx, xRxPxh LaTonage Xxxxxx Pharm.D., MBA Address: _0000 Xxxxx Xx XX 2412 Cuming St Title: Regional VP of Operations – Midwest West Division City/State/Zip: _Xxxxxxxxxxxx, Xxxxx XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 NE 23544 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-28 A-26 Exhibit A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Pharmaceutical Care Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Xxxxx Xxx Xxxxxx Signature: Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX 00 Xxxxxx Xx, Xxx X Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Scarborough ME 04074 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 MD14388 Phone#: _000-000-0000 0000000000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 1_/_5_/_2022 Date: 12/2/2021 11/22/2021 | 1:22 PM CST 11:44 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-25 A-24 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 A-25 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-28 A-26 Exhibit A-26 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-27 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-28 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-29 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Treatment Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X XxxxxSignature: Xxxx Xxxxxx, MD Signature: Signature: Print Name: _Richard X XxxxxLane Beatty, MD Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS 000 Xxxxxxx Xxxxx Xx. Xxxxx 0 Address: _0000 Xxxxx Xx Xxxxxxxx, XX 00000 City/State/Zip: Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 NH 11344 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST 11:37 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf RPh may not administer in New Hampshire Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Daniel B_auer Address: _000 Xxxxxxxx Xxx Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxxxx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX RPh Title: Regional VP of Operations – Midwest South Division City/State/Zip: _Xxxxxxxxxxxx, Xxxxxxxxx XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 0000-0000 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30Dec 13, 2021 Date: 12/2/2021 12/14/2021 | 1:22 1:55 PM CST PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in North Carolina Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in North Carolina Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in North Carolina Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in North Carolina Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in North Carolina Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in North Carolina Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in North Carolina Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in North Carolina Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in North Carolina Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in North Carolina Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in North Carolina Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in North Carolina Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in North Carolina Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in North Carolina Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in North Carolina Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in North Carolina Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit X-00 XXXXX-00 Vaccines Moderna: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/moderna/downloads/standing-orders.pdf Pfizer-BioNTech: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/pfizer/downloads/standing-orders.pdf Xxxxxxx, Inc (Xxxxxxx & Xxxxxxx): xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/xxxxxxx/downloads/Xxxxxxx-Standing-Orders.pdf Minimum Screening Questionnaire for Immunizing Pharmacists (Comments in italics are notes for use in applying questionnaire, but do not need to be present on patient copy to meet minimum standards.) Final version (8.30.13)
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Authorizing Physician Signature: Signature: Print Name: _Richard X Xxxxx, MD Xxxxx Xxxxx Signature: Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX Xxxxxxx Xxxxxx Title: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxXxxx, XX Xxx Xxxx 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 NY 157143 Phone#: _000-000-0000 CityDate: Jan 3, 0000 Xxxx/StateXxxxx/ZipXxx: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 1/4/2022 | 1:22 PM CST 7:53 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Xxxxxx Xxxxxxxx Signature: Signature: Print Name: _Richard X Xxxxx, MD Daniel Xxxxxxxx Print Name: JxoxyxxHxoxlmxxaxnxAmr Elebiary, xRxPxh LaTonage Xxxxxx Pharm.D., MBA Address: _0000 S7563 Xxxxx Xx XX Title: Regional VP of Operations – Midwest West Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 29039 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Authorizing Physician Signature: Signature: Print Name: _Richard X Xxxxx, MD Mark Xxxxxxx Signature: Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX 000 Xxxxxxx Xxxxxx, xxxxx 000 Title: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxXxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 NY 201382 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30Jan 3, 2021 2022 Date: 12/2/2021 1/4/2022 | 1:22 PM CST 7:53 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxxxx Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnxRPh, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX MS Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: XxxxxxRenton, XX 00000 WA 98057 Phone#: (000) 000-0000 Date:1/3/2022 | 11:14 AM PST 856-764-1483 Dec 27, 2021 Phone#: Date: Print Name:Xxxxx Xxxxxxxx D.O. Address: _Nov 304318 Xxxxx 000X Xxxx/Xxxxx/Xxx: Xxxxxxxxxxx, 2021 DateXX 00000 Medical License#: 12/2/2021 | 1:22 PM CST _25MB07308300 Xxxxx Xxxxxxxx D.O. Signature: Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Authorizing Physician Signature: 1/3/2022 | 11:14 AM PST Date: Signature: Print Name: _Richard X Xxxxxxx Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnxRPh, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX MS Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical LicenseCity/State/Zip: Renton, WA 98057 Phone#: _OH 00 000000 (000) 000-0000 Dec 27, 2021 Date: Phone#: _000-000-0000 City25MB07308300 Medical License#: Signature: Xxxxx Xxxxxxxx D.O. Print Name:Xxxxx Xxxxxxxx D.O. Address: 0000 Xxxxx 000X Xxxx/StateXxxxx/ZipXxx: Xxxxxx_Xxxxxxxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD John R Bogdasarian Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX 00 Xxxxxxxx Xxxxxx, Xxx 000 Title: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 MA 33995 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 1/5/22 Date: _Nov 30, 2021 Date: 12/2/2021 11/19/2021 | 1:22 PM CST 9:38 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-28 Japanese Encephalitis X-00 Xxxxxxx X-00 Xxxxxxxx Xxxxxxxxxxxx – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Massachusetts
Appears in 1 contract
Samples: Standing Order Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: [Signature Page Follows] Signature: Print Name: _Richard Xxxxx X Xxxxxxxx Address: _1181 Xxxx 000xx Xxx Xxxx/Xxxxx/Xxx: _Xxxxxxxx, MD XX 00000 Signature: Print Name: JxoxyxxHxoxlmxxaxnxAmr Elebiary, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Pharm.D., MBA Title: Regional VP of Operations – Midwest West Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#Authorizing Practitioner Signature: _OH 00 000000 Phone#Genoa Healthcare, LLC: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: 11/19/2021 | 9:37 AM PST Medical License#: _Nov 30, 2021 46156 Phone#: _000-000-0000 Date: 12/2/2021 | 1:22 PM CST _1/5/22 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Pharmacist Administered Vaccines
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature1/4/2022 | 7:53 AM PST Date: Signature: Print Name: _Richard X Xxxxxxx Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnxRPh, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX MS Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Jim Li Address: _000 Xxxxx Xxxxxx, Xxx 000 City/State/Zip: _Xxx Xxxx, XX 00000 Medical License#: _OH 00 000000 NY 224860 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30Jan 3, 2021 Date: 12/2/2021 | 1:22 PM CST 2022 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X XxxxxSignature: Xxxx Xxxxxx, MD Signature: Signature: Print Name: _Richard X XxxxxLane Xxxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS 000 Xxxxxxx Xxxxx Xx. Xxxxx 0 Address: _0000 Xxxxx Xx Xxxxxxxx, XX 00000 City/State/Zip: Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 NH 11344 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST 11:37 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx RPh may not administer in New Hampshire Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx RPh may not administer in New Hampshire Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf RPh may not administer in New Hampshire Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx RPh may not administer in New Hampshire Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. 12/14/2021 | 1:55 PM PST Date: Signature: Print Name: Xxxxxxx Xxxxxxx, RPh Title: Regional VP of Operations – South Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Andrew Magnet, MD, PhD Address: _2000 Xxx Xxxxxxx City/State/Zip: _Xx. Xxxxx, XX 00000 Medical License#: _60215 Phone#: _000-000-0000 Date: _Dec 14, 2021 Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Title: Regional VP of Operations – Midwest Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Georgia Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Georgia Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Georgia Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Georgia Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Georgia Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Georgia Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Georgia Exhibit A-32 A-27 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-28 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit X-00 XXXXX-00 Vaccines Moderna: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/moderna/downloads/standing-orders.pdf Pfizer-BioNTech: xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/pfizer/downloads/standing-orders.pdf Xxxxxxx, Inc (Xxxxxxx & Xxxxxxx): xxxxx://xxx.xxx.xxx/vaccines/covid-19/info-by- product/xxxxxxx/downloads/Xxxxxxx-Standing-Orders.pdf Attachment 1: Pharmacist Affidavit to Qualifications AFFIDAVIT OF STATE OF GEORGIA COUNTY OF Personally appeared before me, the undersigned officer who is duly authorized by law to administer oaths, , who, after first being sworn, states the following of (his/her) own personal knowledge:
Appears in 1 contract
Samples: Vaccine Protocol Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature Page Follows Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Authorizing Practitioner Signature: Signature: Print Name: _Richard X XxxxxAmr Elebiary, MD Print Name: JxoxyxxHxoxlmxxaxnxPharm.D., xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX MBA Title: Regional VP of Operations – Midwest West Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: XxxxxxRenton, XX 00000 WA 98057 Phone#: (000) 000-0000 Date: 11/19/2021 | 9:37 AM PST Print Name: _Nov 30Laura Xxxxxx Address: _10301 Glacier Highway City/State/Zip: _Juneau, 2021 AK 99801 Medical License#: _AK5574 Phone#: _000-000-0000 Date: 12/2/2021 | 1:22 PM CST _1/5/22 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: [Signature Page Follows] Signature: Print Name: _Richard X Elisa G Xxxxxxxx Address: _1181 Xxxx 000xx Xxx Xxxx/Xxxxx/Xxx: _Xxxxxxxx, MD XX 00000 Signature: Print Name: JxoxyxxHxoxlmxxaxnxAmr Elebiary, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Pharm.D., MBA Title: Regional VP of Operations – Midwest West Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#Authorizing Practitioner Signature: _OH 00 000000 Phone#Genoa Healthcare, LLC: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: 11/19/2021 | 9:37 AM PST Medical License#: _Nov 30, 2021 46156 Phone#: _000-000-0000 Date: 12/2/2021 | 1:22 PM CST _1/5/22 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Pharmacist Administered Vaccines
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Zaid Xxxxx Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX One Hospital Plaza Title: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 51568 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 2/5/22 Date: 12/2/2021 11/19/2021 | 1:22 PM CST 9:38 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Connecticut Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Connecticut Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Connecticut Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Connecticut Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Connecticut Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Connecticut Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf Not permitted by protocol in Connecticut Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Connecticut Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Connecticut Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Connecticut Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Connecticut Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Connecticut
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] Authorizing Physician Signature: Genoa Healthcare, LLC: 11/19/2021 | 2:31 PM PST Date: Signature: Print Name: Xxxxxxx Xxxxxxx, RPh Title: Regional VP of Operations – South Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Xxxxxx Xxxxx Address: _000 X Xxxxxxxx Xxxx Xxxx City/State/Zip: _Boca Raton, FL 33432 Medical License#: _ME 108693 Phone#: _000-000-0000 Date: _1/5/22 The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Title: Regional VP of Operations – Midwest Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Florida. Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Florida. Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Florida. Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Florida. Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Florida. Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-25 A-24 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 A-25 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx japanese- encephalitis-standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx vaccine- standing-order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx fever- standing-order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Florida.
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] Authorizing Physician Signature: Genoa Healthcare, LLC: 11/19/2021 | 2:31 PM PST Date: Signature: Print Name: Xxxxxxx Xxxxxxx, RPh Title: Regional VP of Operations – South Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Cedric Xxxxx Address: _000 X Xxxxxxxx Xxxx Xxxx Xxxx/Xxxxx/Xxx: _Xxxx Xxxxx, XX 00000 Medical License#: _ME 108693 Phone#: _000-000-0000 Date: _1/5/22 The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Title: Regional VP of Operations – Midwest Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Florida. Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Florida. Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Florida. Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Florida. Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Florida. Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Florida. Exhibit A-25 A-24 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 A-25 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx japanese- encephalitis-standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx vaccine- standing-order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx fever- standing-order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Florida.
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard Xxxx X Xxxxx, MD Xxxxxxxxxxx Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX 00 Xxxxxxxx Xxxxxx, Xxx 000 Title: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 MA 33995 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 1/5/22 Date: _Nov 30, 2021 Date: 12/2/2021 11/19/2021 | 1:22 PM CST 9:38 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-28 Japanese Encephalitis X-00 Xxxxxxx X-00 Xxxxxxxx Xxxxxxxxxxxx – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Massachusetts Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxNot permitted by protocol in Massachusetts
Appears in 1 contract
Samples: Standing Order Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD zaheer shah Address: _65 Xxxxx Xxxxxxx Highway Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX RPh, MS Title: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxX. Xxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 RI MD 9877 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30Dec 2, 2021 Date: 12/2/2021 12/13/2021 | 1:22 1:50 PM CST PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Rhode Island Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit Not permitted by protocol in Xxxxx Xxxxxx Xxxxxxx X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Rhode Island Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Rhode Island Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Rhode Island Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Xxxxxxx Xxxxxxx MD Signature: Print Name: _Richard X Xxxxx, William Xxxxxxx MD Print Name: JxoxyxxHxoxlmxxaxnxAmr Elebiary, xRxPxh LaTonage Xxxxxx Pharm.D., MBA Address: _0000 Xxxxx Xx XX 2412 Cuming St Title: Regional VP of Operations – Midwest West Division City/State/Zip: _Xxxxxxxxxxxx, Xxxxx XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 NE 23544 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-28 A-26 Exhibit A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Pharmaceutical Care Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Heidi Xxx Xxxxxx Signature: Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX 00 Xxxxxx Xx, Xxx X Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Scarborough ME 04074 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 MD14388 Phone#: _000-000-0000 0000000000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 1_/_5_/_2022 Date: 12/2/2021 11/22/2021 | 1:22 PM CST 11:44 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Maine Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Maine Exhibit A-25 A-24 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 A-25 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-28 A-26 Exhibit A-26 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-27 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-28 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-29 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Treatment Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Practitioner Signature: Genoa Healthcare, LLC: Xxxxxxx X XxxxxXxxxxx X. Xxxxxxxx, MD D.O. Signature: Signature: Print Name: _Richard X XxxxxAndrew X. Xxxxxxxx, MD D.O. Print Name: JxoxyxxHxoxlmxxaxnxAmr Elebiary, xRxPxh LaTonage Xxxxxx Pharm.D., MBA Address: _0000 Xxxxx Xx XX 000 X 00xx Xxxxxx Title: Regional VP of Operations – Midwest West Division City/State/Zip: _XxxxxxxxxxxxXxxxx Xxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 SD 5871 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. 1/4/2022 | 7:53 AM PST Date: Signature: Print Name: Xxxxxxx Xxxxx, RPh, MS Title: Regional VP of Operations – East Division Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _STEVEN XXXXXXXXXX Address: _98 Woodchuck Hollow Road City/State/Zip: _Xxxx Xxxxxx Xxxxx, XX 00000 Medical License#: _NY 181989 Phone#: _000-000-0000 Date: _Jan 3, 2022 Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX Title: Regional VP of Operations – Midwest Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Authorizing Physician Signature: Signature:Xxxxx Xxxxxxxx D.O. Signature: Print Name: _Richard X Xxxxx, MD Xxxxx Xxxxxxxx D.O. Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX Title000X Xxxxx: Regional VP of Operations – Midwest East Division Xxxxxxxxxxx, XX 00000 City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 25MB07308300 City/State/Zip: Xxxxxx, XX 00000 Phone#: 000-000-0000 Phone#: (000) 000-0000 Date: _Nov 30Dec 27, 2021 Date: 12/2/2021 1/3/2022 | 1:22 PM CST 11:14 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Xxxxx Xxxxxxxx D.O. Signature: Print Name: _Richard X Xxxxx, MD Xxxxx Xxxxxxxx D.O. Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX 4318 Route 130N Title: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 25MB07308300 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Date: _Nov 30Dec 27, 2021 Date: 12/2/2021 1/3/2022 | 1:22 PM CST 11:14 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature1/4/2022 | 7:53 AM PST Date: Signature: Print Name: _Richard X Xxxxxxx Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnxRPh, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX MS Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 Signature: Print Name: _Mark Xxxxxxx Address: _000 Xxxxxxx Xxxxxx, xxxxx 000 Xxxx/Xxxxx/Xxx: _Xxxxxx, XX 00000 Medical License#: _OH 00 000000 NY 201382 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30Xxx 0, 2021 Date0000 Xxxxx Healthcare, LLC: 12/2/2021 | 1:22 PM CST Authorizing Physician Signature: Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit X-00 Xxxxxxxxxxxx A-18 Pneumococcal (XXXX00 PPSV23 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New York Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New York Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: info.genoahealthcare.com
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Xxxxx Xxxxxx Signature: Signature: _ Print Name: _Richard X Xxxxx, MD Peter Shalit Print Name: JxoxyxxHxoxlmxxaxnxAmr Elebiary, xRxPxh LaTonage Xxxxxx Pharm.D., MBA Address: _0000 000 Xxxxx Xx XX Xxxxxx, Suite 850 Title: Regional VP of Operations – Midwest West Division City/State/Zip: _Xxxxxxxxxxxx, Xxxxxxx XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 WAMD00023946 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Date: _Nov 30Jan 19, 2021 2022 Date: 12/2/2021 1/19/2022 | 1:22 PM CST 9:03 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Drug Therapy Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Xxxxx Xxxxxxxx D.O. Signature: Signature: Print Name: _Richard X Xxxxx, MD Xxxxx Xxxxxxxx D.O. Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX Title000X Xxxxx: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 25MB07308300 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Date: _Nov 30Dec 27, 2021 Date: 12/2/2021 1/3/2022 | 1:22 PM CST 11:14 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Xxxxx Xxxxxxxx D.O. Signature: Signature: Print Name: _Richard X Xxxxx, MD :Xxxxx Xxxxxxxx D.O. Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx RPh, MS Address: _0000 Xxxxx Xx XX Title000X Xxxxx: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 25MB07308300 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Date: _Nov 30Dec 27, 2021 Date: 12/2/2021 1/3/2022 | 1:22 PM CST 11:14 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in New Jersey Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in New Jersey Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Standing Order (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Practitioner Signature: Genoa Healthcare, LLC: Xxxxxxx X XxxxxXxxxxx X. Xxxxxxxx, MD D.O. Signature: Signature: Print Name: _Richard X XxxxxXxxxxx X. Burchett, MD D.O. Print Name: JxoxyxxHxoxlmxxaxnxAmr Elebiary, xRxPxh LaTonage Xxxxxx Pharm.D., MBA Address: _0000 Xxxxx Xx XX 000 X 00xx Xxxxxx Title: Regional VP of Operations – Midwest West Division City/State/Zip: _XxxxxxxxxxxxXxxxx Xxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 SD 5871 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST 10:18 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Authorizing Physician Signature: Signature: Print Name: _Richard X Xxxxx, MD Abigail XxXxxx DO Signature: Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxxxx, xRxPxh LaTonage Xxxxxx RPh Address: _0000 000 Xxxxxx Xxxxxx Xxxx, Xxxxx Xx XX X0 Title: Regional VP of Operations – Midwest South Division City/State/Zip: _XxxxxxxxxxxxBowling Xxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 03735 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30Jan 5, 2021 2022 Date: 12/2/2021 1/7/2022 | 1:22 PM CST 7:50 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by KY pharmacists.4 Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxxxxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx 4 Per a December 20, 2013 telephone call with Xxxxxx Xxxxxx (Immunization Assessment Coordinator), for the Kentucky Cabinet for Health and Family Services, Department of Health at (000) 000-0000 x 0000 stated pharmacies or pharmacist can't apply for a yellow fever stamp, only a Kentucky licensed physician is allowed to be in possession of a yellow fever stamp.
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Authorizing Physician Signature: Xxxxxxx X XxxxxX. Xxxxxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD Xxxxxxx Xxxxxxxx Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxxxx, xRxPxh LaTonage Xxxxxx RPh Address: _0000 Xxxxx Xx XX Xxxxxxxx Xxxx Title: Regional VP of Operations – Midwest South Division City/State/Zip: _XxxxxxxxxxxxXxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 AL 25447 City/State/Zip: Xxxxxx, XX 00000 Phone#: _000-000-0000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 1/5/22 Date: 12/2/2021 11/19/2021 | 1:22 2:31 PM CST PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – - Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) )– Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – - Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) )– Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – - Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – - Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 A-27 Japanese Encephalitis – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – - Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Not permitted by protocol in Alabama5 Exhibit A-32 A-30 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx 5 Per a telephone conversation with Xxxxx, a nurse with the Immunization Division (0-000-000-0000) Alabama Department of Public Health Immunization Division, Alabama will not allow pharmacists or pharmacies to hold the Yellow Fever stamp. (December 11, 2013) Exhibit A-33 A-31 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature Page Follows Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Authorizing Practitioner Signature: Signature: Print Name: _Richard X XxxxxAmr Elebiary, MD Print Name: JxoxyxxHxoxlmxxaxnxPharm.D., xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX MBA Title: Regional VP of Operations – Midwest West Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 Phone#: _000-000-0000 City/State/Zip: XxxxxxRenton, XX 00000 WA 98057 Phone#: (000) 000-0000 Date: 11/19/2021 | 9:37 AM PST Print Name: _Nov 30Xxxxx Xxxxxx Address: _10301 Glacier Highway City/State/Zip: _Juneau, 2021 AK 99801 Medical License#: _AK5574 Phone#: _000-000-0000 Date: 12/2/2021 | 1:22 PM CST _1/5/22 Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 A-27 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 A-28 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 A-29 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 A-30 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 A-31 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 A-32 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Authorizing Physician Signature: Signature: Print Name: _Richard X Xxxxx, MD Xxxxxx X. Duclos Signature: Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxxxx, xRxPxh LaTonage Xxxxxx RPh Address: _0000 Xxxxx Xx XX Xxxx Xxxxxx Title: Regional VP of Operations – Midwest South Division City/State/Zip: _XxxxxxxxxxxxXxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 TN 53162 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 Date: 12/2/2021 | 1:22 PM CST 10:28 AM PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Yellow Fever stamps are not provided to pharmacists or pharmacies Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxx, MD xxxxxx xxxx Address: _65 Xxxxx Xxxxxxx Highway Print Name: JxoxyxxHxoxlmxxaxnxXxxxxxx Xxxxx, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX RPh, MS Title: Regional VP of Operations – Midwest East Division City/State/Zip: _XxxxxxxxxxxxX. Xxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 Medical License#: _OH 00 000000 RI MD 9877 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30Dec 2, 2021 Date: 12/2/2021 12/13/2021 | 1:22 1:50 PM CST PST Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Rhode Island Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit Not permitted by protocol in Xxxxx Xxxxxx Xxxxxxx X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Rhode Island Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Rhode Island Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Rhode Island Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Rhode Island Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 yr) See Exhibit A-27 Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Protocol (Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxxxx Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnxRPh, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX MS Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 12/2/2021 | 11:37 AM PST Date: Signature: Print Name: _Xxxxxxx Xxxxxx, MD Address: _000 Xxxxx Xx Xxx 000 Xxxx/Xxxxx/Xxx: _Xxxx, XX 00000 Medical License#: _OH 00 000000 MD440690 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 DateAuthorizing Physician: 12/2/2021 | 1:22 PM CST Genoa Healthcare, LLC: Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Pennsylvania Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Pennsylvania Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Pennsylvania Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Pennsylvania Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Pennsylvania Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
Severability and Waiver. The invalidity or unenforceability of any term or provision of this Agreement must in no way affect the validity or enforceability of any other term or provision. The waiver by either Party of a breach of any provision of this Agreement must not operate as or be construed as a waiver of any subsequent breach thereof. [Signature Page Follows] The undersigned represent that they are duly authorized to execute this Agreement on behalf of the party for whom they sign; and such party shall be bound by the terms of this Agreement. Authorizing Physician Signature: Genoa Healthcare, LLC: Xxxxxxx X Xxxxx, MD Signature: Signature: Print Name: _Richard X Xxxxxxx Xxxxx, MD Print Name: JxoxyxxHxoxlmxxaxnxRPh, xRxPxh LaTonage Xxxxxx Address: _0000 Xxxxx Xx XX MS Title: Regional VP of Operations – Midwest East Division City/State/Zip: _Xxxxxxxxxxxx, XX 00000 Address: 000 X. Xxxxx Way, Suite 700 City/State/Zip: Renton, WA 98057 Phone#: (000) 000-0000 12/2/2021 | 11:37 AM PST Date: Signature: Print Name: _Annette Xxxxxx, MD Address: _000 Xxxxx Xx Xxx 000 Xxxx/Xxxxx/Xxx: _Xxxx, XX 00000 Medical License#: _OH 00 000000 MD440690 Phone#: _000-000-0000 City/State/Zip: Xxxxxx, XX 00000 Phone#: (000) 000-0000 Date: _Nov 30, 2021 DateAuthorizing Physician: 12/2/2021 | 1:22 PM CST Genoa Healthcare, LLC: Exhibit A-1 Haemophilus influenzae type b (Hib) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-2 Influenza inactivated and live intranasal – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-3 Haemophilus influenzae type b (Hib) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-4 Influenza inactivated and live intranasal – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-5 Hepatitis A – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-6 Hepatitis A – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-7 Hepatitis B – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-8 Hepatitis B – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-9 HPV – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Pennsylvania Exhibit A-10 HPV – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-11 MMR – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-12 MMR – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-13 Meningococcal (MenACWY) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-14 Meningococcal (MenACWY) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-15 Meningococcal B (MenB) – Children and Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-16 Pneumococcal polysaccharide vaccine (PPSV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-17 Pneumococcal conjugate vaccine (PCV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Pennsylvania Exhibit X-00 Xxxxxxxxxxxx (XXXX00 and PCV13) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-19 Polio (IPV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Pennsylvania Exhibit A-20 Rotavirus (RV) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Pennsylvania Exhibit A-21 Tetanus-diphtheria toxoids & pertussis (DTaP) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Not permitted by protocol in Pennsylvania Exhibit A-22 Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-23a Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-23b Tetanus-diphtheria toxoids & pertussis (Tdap/Td) – Pregnant Women xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Exhibit A-24 Varicella (Chicken Pox) – Children xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx Not permitted by protocol in Pennsylvania Exhibit A-25 Varicella (Chicken Pox) – Adults xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-26 Zoster – Adults CDC Guidance (>60 50 yr) See Exhibit A-27 xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-27 Zoster – Adults FDA Labeling (>50 yr) xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/zoster50.pdf See Exhibit A-26 Exhibit A-28 Japanese Encephalitis – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/japanese-encephalitis- standing-order-9-2015.docx Exhibit A-29 Rabies – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/rabies-vaccine-standing- order-9-2015.docx Exhibit A-30 Typhoid – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/typhoid-vaccine- standing-order-9-2015.docx Exhibit A-31 Yellow Fever – Children and Adults xxxxx://xxxx- xxxx.x0.xxxxxxxxx.xxx/xxxxxxxxxxxx- cpas/vaccine-protocols/yellow-fever-standing- order-9-2015.docx Exhibit A-32 Medical Management of Vaccine Reactions in Adult Patients xxx.xxxxxxxx.xxx/xxxx.x/x0000.xxx Exhibit A-33 Medical Management of Vaccine Reactions in Children and Teens xxx.xxxxxxxx.xxx/xxxx.x/x0000x.xxx
Appears in 1 contract
Samples: Collaborative Agreement
