EXHIBIT 10.7
MAIL SERVICE PROVIDER AGREEMENT
This Agreement is made as of the 1st day of July, 1996 by and between
National Medical Health Card Systems, Inc. (hereinafter "Sponsor"), a
corporation duly organized under New York law, having its principal place of
business at 00 Xxxxxx Xxxx Xxxxx, Xxxx Xxxxxxxxxx, Xxx Xxxx 00000, and Thrift
Drug, Inc., d/b/a Express Pharmacy Services (hereinafter "Express"), a
corporation duly organized under Delaware law, having its principal place of
business at 000 Xxxxx Xxxxx, Xxxxxxxxxx, Xxxxxxxxxxxx 00000.
Whereas, Express through its mail service operation desires to render
certain pharmaceutical services to eligible clients of Sponsor and their
eligible employees and retirees, and Sponsor agrees to the provision of these
services pursuant to the terms and conditions hereinafter stated, it is
therefore agreed as follows:
1. Definitions
(A) "Average Wholesale Price" (AWP) means the wholesale cost of
the Covered Drug(s) for pints, quantities of 100 units, or in
such other quantity at which the Covered Drug(s) is most
commonly sold at wholesale as reported in a nationally
recognized drug medication publication.
(B) "Business Day" means all days of the week but excluding
holidays recognized by the U.S. Postal Service.
(C) "Copayment" means the portion of the Prescription Charge for
which the Covered Person is responsible.
(D) "Covered Drug" means a drug, medication or agent ordered by a
Prescriber which cannot legally be sold without a
Prescription, inclusive of insulin and diabetic supplies,
which ordinarily may be purchased without a Prescription.
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(E) "Covered Person" means an Eligible Member and any of his/her
dependents as to whom Express has been notified of his/her
status in accordance with the provisions of Paragraph 2
hereof.
(F) "Eligible Member" means an employee or retiree of Sponsor's
client, who is entitled to prescription drug benefits in
accordance with and under the terms of the applicable
prescription drug plan of Sponsor.
(G) "Patient Profiles" means the history of all Covered Drugs
dispensed by Express to a Covered Person. It shall also
include drug/drug, drug/allergy, and drug/health condition
alert mechanisms. Drug/allergy and drug/health condition
alerts will be based on information provided by a Covered
Person with respect to a Covered Person to Express. Drug/drug
interaction protection extends to drugs dispensed to Covered
Persons by Express.
(H) "Prescriber" means a person who is legally entitled to
prescribe drugs and medication for humans in the state in
which the Prescriber is licensed.
(I) "Prescription" means an order to dispense a Covered Drug
legally eligible for dispensing under the laws and regulations
of the United States, the Food and Drug Administration, and
the state in which Express' dispensing facility is located,
except for a drug not listed in the Department of Health
Generic Formulary or equivalent Formulary of the state in
which the dispensing facility is located.
(J) "Prescription Charge" is calculated in accordance with the
formula set forth in Schedule A attached hereto and made part
of this Agreement.
(K) "Prescription Request Forms" consist of:
(1) a Prescription, and
(2) an order form, provided by Express, upon which the
Covered Person will be required to provide such
information as Express deems necessary for program
control and administration or for maintaining Patient
Profiles.
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(L) "Client" means a client company of Sponsor for which Sponsor
provides third party administrative services.
2. Coverage
Sponsor shall provide Express with information necessary for Express
to maintain a roster of Covered Persons. Express and Sponsor will
establish mutually satisfactory procedures to maintain such roster.
3. Enrollment Materials and Claim Forms
Express shall bulk ship to Sponsor or Client, for Sponsor's or
Client's distribution to Eligible Members, an enrollment package
including a carrier envelope, a brochure describing the details of
the services provided by Express, a postage paid order envelope, an
employer announcement letter and patient profile request forms.
Express will provide adequate supplies of packets to Sponsor for use
in soliciting Eligible Members. Express will be willing to customize
brochures beyond the standard brochure for groups of at least five
thousand (5,000) employees or groups that will generate in excess of
approximately fifty-five hundred (5,500) or more Prescriptions per
year.
4. Provision of Covered Drugs
Express will provide Covered Drugs to all Covered Persons in the
United States and Puerto Rico who have provided Express with
Prescription Request Forms containing sufficient information to
maintain a Patient Profile. As provided in Schedule B attached
hereto and made part hereof, prescriptions will be mailed to Covered
Persons within two Business Days of receipt of such Covered Person's
Prescription Request Forms, subject to product availability and the
need to contact the Covered Person's physician for prescription
clarification. Express shall furnish the lowest cost drug consistent
with the Prescription Plan
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parameters and the requirements of the law of the state in which the
dispensing facility is located. If the Covered Drug is prescribed in
generic terms, or in such a way as to permit generic dispensing,
Express shall dispense the lowest cost A-Rated drug it then has in
stock which meets the specifications set forth in the United States
Pharmacopoeia or the National Formulary if such drug is listed
therein and which, in the professional judgment of the dispensing
pharmacist fulfills the requirements of the Prescription. Nothing
herein shall affect the right of Express to refuse to dispense a
Covered Drug which in the professional judgment of the licensed
pharmaceutical staff of Express should not be dispensed. Express
shall dispense Covered Drugs in accordance with the requirements of
Federal law and the law of the state in which the dispensing
facility is located.
5. Copayment
(A) Express will collect from a Covered Person for each
Prescription or refill of a Covered Drug, the full Copayment
amount, if any, as determined by Sponsor and subject to change
from time to time. Sponsor agrees to communicate Copayment
changes to Express prior to the effective date of the change
for the sole purpose of addressing customer service inquiries
or calls that may be received from the Covered Persons.
(B) Generic Penalties. In the event a plan design requires that a
Covered Person pay an additional out-of-pocket expense if a
brand name drug is purchased where a generic brand is
available, Express will collect said amount.
6. Maximum Quantity to be Dispensed
Express will provide the quantity of the Covered Drug specified by
the Prescriber on the Prescription submitted, with the following
qualifications, regarding quantities:
(a) Express will not provide more than a 90-day supply of a
Covered Drug under any Prescription or refill.
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(b) Dispensing of certain Schedule II "controlled" substances as
defined by the Drug Enforcement Agency will be limited to a
30-day supply and no refill will be permitted.
7. Reimbursement for Services
Sponsor shall, in consideration of Express' provision of pharmacy
services to Sponsor's Covered Persons, reimburse Express for claims
submitted that have been adjudicated in accordance with the
Sponsor's benefit plan. Reimbursement shall be at the levels listed
in Schedule A or applicable subsequent schedules less any plan
copayment, coinsurance or deductible. Reimbursement for services
shall occur within forty-five (45) days of the end of the applicable
claims period. For purposes of this agreement, "claims period" shall
mean the two-week processing cycles within which claims have been
submitted to Sponsor and approved for pharmacy services as reflected
in Schedule D attached hereto and made part of this agreement.
Sponsor will agree to pay interest on the outstanding balance equal
to the Thrift Drug, Inc. cost of funds (currently 8%) multiplied by
the balance for days outstanding beyond the forty-five (45) day
term. Thrift's cost of funds will be reviewed and updated every
ninety (90) days to reflect the current value as determined by the
Thrift Drug Treasurer's Department.
8. Exclusions
Sponsor shall have no obligation to pay Express for any drug or
medication dispensed by Express which is not a Covered Drug or
dispensed to anyone who is not a Covered Person.
9. Indemnity
Express agrees to indemnify and hold Sponsor, its officers, agents,
and employees harmless from any and all liability, penalties, fines,
claims or demands (including the costs, expenses, and reasonable
attorney(s) fees on account thereof) caused by, arising out of, or
in any way
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related to the sale, compounding, dispensing, failure to sell,
failure to deliver, or use of any Covered Drug dispensed to Covered
Persons pursuant to this Agreement, except that Express shall have
no liability and shall be similarly indemnified by Sponsor for any
action, suit, liability, penalty, claim, or demand which alleges a
failure to dispense by Express in which the failure is with respect
to a person who is not a Covered Person.
10. Insurance
Express shall maintain, during the term of this Agreement, insurance
coverage including, but not limited to, comprehensive general
liability insurance, products liability insurance, and Worker's
Compensation Insurance. Express shall furnish to Sponsor, as
evidenced in Schedule C attached hereto and made of this Agreement,
certificates of such insurance. At its sole discretion, Express may
elect to self-insure all or a part of its insurance obligations. In
such event, at Sponsor's request, Express will furnish to Sponsor a
statement of self-insurance.
11. Maintenance and Inspection of Records
Express shall maintain detailed business records and Prescription
files directly related to the dispensing of Covered Drugs provided
to Covered Persons under the terms of this Agreement. Express will
maintain such eligibility, address, and claim history files as are
necessary for its performance of this Agreement. Sponsor shall have
the right at reasonable intervals and during regular business hours
of Express to review such business records and Prescription files of
Express to the extent they directly relate to the performance of
this Agreement. Notwithstanding the foregoing, Sponsor's right to
review such business records and Prescription files, relating to the
performance of this Agreement, will expire five (5) years after the
filling/refilling of a Prescription and shall survive termination of
this Agreement.
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12. Exclusivity
Express understands that Sponsor wishes to appoint Express as the
provider of first choice for mail service prescription drug programs
managed by Sponsor. Express recognizes that in certain instances,
Sponsor and member programs may elect to use a mail service pharmacy
other than Express.
13. Warranties
Express hereby warrants as follows:
(a) That it has been duly licensed as a professional pharmacy
under the laws of the states in which it has dispensing
facilities.
(b) That it is in full compliance with all federal, state, and
local laws and regulations, governing the sites upon which
dispensing facilities are located and are applicable to the
filling of prescriptions by mail and that its compliance with
the terms of this Agreement will not violate the provisions of
any third party prescription drug law.
(c) That by entering into this Agreement Express is not in
violation of any agreement with any other third party carrier.
14. Termination
The initial term of this Agreement shall be 36 months, commencing on
the date set forth above. This Agreement will be automatically
renewed for 12 month renewal terms, unless either party gives
written notice not less than 90 days prior to the expiration of the
initial term, the first renewal term or subsequent renewal term of
its desire to terminate this Agreement. Upon receipt of said notice
of termination, the Agreement shall terminate at the expiration of
the then current term. In the event of the termination of this
Agreement Express shall, at the option of Sponsor, continue to
arrange for the provision of mail order
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service for Covered Persons currently receiving mail order service
on the effective date of termination until such time as other
provisions for mail service can be made.
15. Non-Exclusive and Non-Solicitation
Nothing contained herein shall be construed to limit in any way,
Express' ability to participate in other prescription drug programs.
Express agrees that it will not directly solicit any of Sponsor's
clients for whom Express is the mail service provider nor have any
direct contact with said clients unless requested to do so by
Sponsor. All correspondence and reporting will be directed to
Sponsor, unless requested to do otherwise.
16. Independent Contractor
Both parties declare and agree that Express is engaged in an
independent business and will perform its obligations under this
Agreement as an independent contractor and that nothing contained
herein shall be construed to mean that Express is an agent or
partner of Sponsor.
17. Assignment
Neither party shall assign this Agreement without the express
written consent of the other, such consent will not be unreasonably
withheld, except that this Agreement may be assigned by either party
to a parent or subsidiary of the assignor.
18. Subcontracting
Neither party shall subcontract any of its obligations hereunder
without the prior written consent of the other party, such consent
will not be unreasonably withheld. Any subcontracting pursuant to
the terms of this Paragraph shall not alleviate the contracting
party of its obligations hereunder.
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19. Notice
Any notices required or permitted to be sent hereunder shall be
addressed as follows and shall be delivered by hand (against
receipt) or mailed, certified mail, prepaid, return receipt
requested:
If to Express:
Thrift Drug, Inc.
000 Xxxxxxx Xxxxx
Xxxxxxxxxx, XX 00000
ATTN: X. X. Xxxxxxx
President
Express Pharmacy Services
If to Sponsor:
National Medical Health Card Systems, Inc.
00 Xxxxxx Xxxx Xxxxx Xxxx Xxxxxxxxxx, XX
00000
ATTN: Xx. Xxxxx Xxxxxxx
President
---------------------------------
Or at such other address as any of the parties hereto shall notify
the other in writing in accordance with this Paragraph 19.
20. Governing Law
This Agreement shall be governed by the substantive laws in the
jurisdiction of the defending party.
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21. Waiver, Amendment or Modification
Any waiver, amendment or modification of any of the provisions of
this Agreement or any right, power or remedy hereunder shall not be
effective unless made in writing and signed by the party against
whom enforcement of such waiver, amendment or modification is
sought. No failure or delay by either party in exercising any of its
rights hereunder shall operate as a waiver thereof.
22. Entire Agreement
This Agreement and the schedule or schedules attached hereto
constitute the entire understanding between the parties in
connection with the subject matter hereof and supersede all prior
and contemporaneous agreements, understanding, negotiations and
discussions, whether oral or written, of the parties, and there are
no warranties, representations and/or agreements among the parties
in conjunction with the subject matter hereof except as set forth in
this Agreement.
23. Force Majeure
Neither Express nor Sponsor shall be liable for a failure or delay
in performance hereunder arising from acts of God, acts of a public
enemy, acts of a sovereign nation or any state or political
subdivision or any department or regulatory agency thereof or entity
created thereby, acts of any person engaged in a subversive activity
or sabotage, fires, floods, explosions, strikes, slow-downs,
lockouts or labor stoppage, or freight embargoes, unless caused by
either party.
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24. Use of Name
Neither party shall use the other party's name, trademarks, logo or
the name of any affiliated company in any advertising or promotional
material, or otherwise, without the prior written consent of the
other party.
25. Waiver of Breach
Waiver of a breach of any provision of this Agreement shall not be
deemed a waiver of any other breach of the same or a different
provision.
26. Severability
In the event that a provision of this Agreement is rendered invalid
or unenforceable, or declared null and void by any court of
competent jurisdiction, the remaining provisions of this Agreement
will remain in full force and effect.
27. Headings
The headings contained in this Agreement are for reference purposes
only and shall not affect in any way the meaning or interpretation
of this Agreement.
28. Performance Guarantees
Express guarantees to Sponsor performance of the services set forth
in Schedule B, attached hereto and incorporated herein by reference.
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IN WITNESS WHEREOF, the parties hereto have executed and delivered this
Agreement as of the date and year first above written.
NATIONAL MEDICAL HEALTH CARD THRIFT DRUG, INC.
SYSTEMS, INC.
BY: Xxxxx Xxxxxxx BY: /s/ [ILLEGIBLE]
--------------------------- --------------------------
TITLE: President TITLE: President
Express Pharmacy Services
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SCHEDULE A
The following tier pricing is dependent on Prescription volume. Changes to
the Prescription Charge outlined below will occur after the new volume is
attained and maintained for two consecutive months. Within fifteen (15) days of
the end of the second month, Express shall provide confirmation of the
attainment level and Sponsor shall implement the attained level of pricing.
Express shall pay Sponsor quarterly an administration fee of fifty cents
($0.50) per Prescription for the Vytra plan through the term of this Agreement
and thereafter if Sponsor chooses not to include Vytra in its volume thresholds.
Vytra volume shall not contribute to the Prescription volume thresholds or
affect the level of tier pricing. Pricing may be reviewed periodically in
accordance with both parties.
FORMULARY DRUG MANAGEMENT AND INTERVENTION (VYTRA HMO ONLY):
Express Pharmacy Services shall perform the following:
1) Maintain knowledge of the formulary provided by Sponsor for the Vytra
HMO.
2) Intervene with the physician when a non-formulary drug has been
prescribed. Express will contact the patient's physician to obtain their
consent to convert to a formulary compliant and therapeutic equivalent
medication.
3) Provide Sponsor with weekly and/or monthly reports of the drug
conversions and attempt of conversions.
Express will place calls to the physician at no additional charge
providing the interventions required total 5% or less of the total number of
Vytra HMO mail service Prescriptions. Should the interventions required exceed
5% of the total number of mail service Prescriptions, Express will invoice
Sponsor $4.00 for each formulary intervention attempted with the physician. This
additional charge will be waived for the initial thirty (30) days of the
program.
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Prescription Charge:
PRESCRIPTION
VOLUME
PER MONTH BRANDS GENERICS
0-7,500 Average Wholesale Price minus NMHC MAC* plus a $1.75
17% with $0.00 dispensing fee dispensing fee
7,501 - 15,000 Average Wholesale Price minus NMHC MAC* plus a $1.75
18% with $0.00 dispensing fee dispensing fee
More than 15,001 Average Wholesale Price minus NMHC MAC* plus a $1.75
19% with $0.00 dispensing fee dispensing fee
*Generic drug pricing at the Maximum Allowable Cost or MAC means the
reimbursement level that is specific to groups of pharmaceutical equivalent
drugs as established by National Medical Health Card Systems, Inc. located at 00
Xxxxxx Xxxx Xxxxx, Xxxx Xxxxxxxxxx, Xxx Xxxx 00000.
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SCHEDULE B
Prescription Turnaround Time Guarantee:
Express will guarantee that 95% of all mail service pharmacist-approved
prescriptions received during each year of the plan will be shipped within an
average of two (2) Business Days from the date of receipt. Express will track
all prescription dispensing activity. If the turnaround time for
pharmacist-approved prescriptions received exceeds an average of two (2)
Business Days for more than 5% of all pharmacist-approved prescriptions during
each year of the plan, a penalty of $3,500 will be paid. Pharmacist-approved
prescriptions are defined as those prescriptions for which product is available
in the pharmacy and which do not require the pharmacist to contact the
prescriber for clarification, consultation or intervention before dispensing.
The availability of such product in the pharmacy shall be applicable only in the
event a product becomes unavailable to the open market due to a manufacturer's
shortage. In this instance, Express agrees to notify Sponsor of same immediately
and such product will be exempted from the aforementioned turnaround time
guarantee until the shortage has ended.
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SCHEDULE C
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Certificate of Insurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND
DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED
BELOW.
--------------------------------------------------------------------------------
This is to Certify that
LIBERTY MUTUAL
THRIFT DRUG, INC. Name and [LOGO]
0000 XXXXXX XXXXX address of
XXXXXX XXXX, XX 00000 insured
Is, at the issue date of this certificate, insured by the Company under the
policy(ies) listed below. The insurance afforded by the listed policy(ies) is
subject to [ILLEGIBLE] terms, exclusions and conditions and is not altered by
any requirement, term or condition of any contract or other document with
respect to which this certificate [ILLEGIBLE] issued.
------------------------------------------------------------------------------------------------------------------------------------
EXP. DATE
|_| CONTINUOUS
TYPE OF POLICY |_| EXTENDED POLICY NUMBER LIMIT OF LIABILITY
|X| POLICY TERM
------------------------------------------------------------------------------------------------------------------------------------
COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY
LAW OF THE FOLLOWING STATES: ------------------------------------
Bodily Injury By Accident
WC2-621-004072-106 WY 1,000,000 [ILLEGIBLE]
[ILLEGIBLE]
WORKERS ------------------------------------
COMPENSATION 02/01/97 CA, CT, MA, MI, NH, NJ, NY, Bodily Injury By Disease
XX0-00X-000000-000 XX, VT 1,000,000 [ILLEGIBLE]
[ILLEGIBLE]
------------------------------------
Bodily Injury By Disease
1,000,000 [ILLEGIBLE]
[ILLEGIBLE]
------------------------------------------------------------------------------------------------------------------------------------
GENERAL LIABILITY BODILY INJURY PROPERTY DAMAGE
------------------------------------------------------------------------------------------------------------------------------------
|X| Comprehensive Form Each Each
$2,000,000 Occurrence $2,000,000 Occurrence
|_| Schedule
|_| Products Completed
Operations
|_| Independent Contractors/ 02/01/97 RG1-621-004072-826
Contractors Protective $2,000,000 Aggregate $2,000,000 Aggregate
|_| Contractural Liability
|X| Pharmacists MALPR
MALPRACTIVE
|_|
------------------------------------------------------------------------------------------------------------------------------------
AUTOMOBILE LIABILITY
|_| OWNED Each Accident - Single [ILLEGIBLE]
B.I. and P.D. Combined
-------------------------------------------------------------------
|_| NON-OWNED Each Person
-------------------------------------------------------------------
Each Accident or Occurrence
-------------------------------------------------------------------
|_| HIRED Each Accident or Occurrence
------------------------------------------------------------------------------------------------------------------------------------
WA POLICY - $500,000 DEDUCTIBLE PER OCCURRENCE APPLICABLE TO PART 1,
WORKERS' COMPENSATION AND PART II EMPLOYERS LIABILITY
------------------------------------------------------------------------------------------------------------------------------------
Location(s) of Operations & Job # (If applicable) Description of Operations:
EXPRESS PHARMACY SERVICES
------------------------------------------------------------------------------------------------------------------------------------
* If the certificate expiration date is continuous or extended term, you will be
notified if coverage is terminated [illegible]
However, you will not be notified annually of the continuation of coverage.
NOTICE OF CANCELLATION: THE COMPANY WILL NOT TERMINATE OR REDUCE THE INSURANCE
AFFORDED UNDER THE ABOVE POLICIES UNLESS 30 DAYS NOTICE OF SUCH TERMINATION OR
REDUCTION HAS BEEN MAILED TO:
THRIFT DRUG, INC. 202
CERTIFICATE 000 XXXXX XXXXX
XXXXXX XXXXXXXXXX. XX 00000
LIBERTY MUTUAL GROUP
/s/ Xxxxxxx X. Xxxxxxxxxx
--------------------------
Xxxxxxx X. Xxxxxxxxxx
AUTHORIZED REPRESENTATIVE
02/01/96 (212) 391-7500 New York office
DATE ISSUED TELEPHONE OFFICE
This certificate is [ILLEGIBLE] by LIBERTY MUTUAL GROUP as respects such
insurance as is afforded by Those Companies
--------------------------------------------------------------------------------
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
UPON YOU THE CERTIFICATE HOLDER. THIS CERTIFICATE IS NOT AN INSURANCE POLICY AND
DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES LISTED
BELOW.
--------------------------------------------------------------------------------
This is to Certify that
LIBERTY MUTUAL
THRIFT DRUG, INC. Name and [LOGO]
0000 XXXXXX XXXXX address of
XXXXXX XXXX, XX 00000 insured
Is, at the issue date of this certificate, insured by the Company under the
policy(ies) listed below. The insurance afforded by the listed policy(ies) is
subject to [ILLEGIBLE] terms, exclusions and conditions and is not altered by
any requirement, term or condition of any contract or other document with
respect to which this certificate [ILLEGIBLE] issued.
------------------------------------------------------------------------------------------------------------------------------------
EXP. DATE
|_| CONTINUOUS
TYPE OF POLICY |_| EXTENDED POLICY NUMBER LIMIT OF LIABILITY
|X| POLICY TERM
------------------------------------------------------------------------------------------------------------------------------------
COVERAGE AFFORDED UNDER WC EMPLOYERS LIABILITY
LAW OF THE FOLLOWING STATES: ------------------------------------
Bodily Injury By Accident
WC2-621-004072-106 WY 1,000,000 [ILLEGIBLE]
[ILLEGIBLE]
WORKERS ------------------------------------
COMPENSATION 02/01/97 CA, CT, MA, MI, NH, NJ, NY, Bodily Injury By Disease
XX0-00X-000000-000 XX, VT 1,000,000 [ILLEGIBLE]
[ILLEGIBLE]
------------------------------------
Bodily Injury By Disease
1,000,000 [ILLEGIBLE]
[ILLEGIBLE]
------------------------------------------------------------------------------------------------------------------------------------
GENERAL LIABILITY BODILY INJURY PROPERTY DAMAGE
------------------------------------------------------------------------------------------------------------------------------------
|X| Comprehensive Form Each Each
$1,000,000 Occurrence $1,000,000 Occurrence
|_| Schedule
|_| Products Completed
Operations
|_| Independent Contractors/ 02/01/97 RG1-621-004072-826
Contractors Protective $1,000,000 Aggregate $1,000,000 Aggregate
|_| Contractural Liability
|_| Pharmacists MALPR
MALPRACTIVE
|_|
------------------------------------------------------------------------------------------------------------------------------------
AUTOMOBILE LIABILITY
|_| OWNED Each Accident - Single [ILLEGIBLE]
B.I. and P.D. Combined
-------------------------------------------------------------------
|_| NON-OWNED Each Person
-------------------------------------------------------------------
Each Accident or Occurrence
-------------------------------------------------------------------
|_| HIRED Each Accident or Occurrence
------------------------------------------------------------------------------------------------------------------------------------
WA POLICY - $500,000 DEDUCTIBLE PER OCCURRENCE APPLICABLE TO PART 1,
WORKERS' COMPENSATION AND PART II EMPLOYERS LIABILITY
------------------------------------------------------------------------------------------------------------------------------------
Location(s) of Operations & Job # (If applicable) Description of Operations:
THRIFT DRUG EXPRESS PHARMACY
------------------------------------------------------------------------------------------------------------------------------------
* If the certificate expiration date is continuous or extended term, you will be
notified if coverage is terminated or reduced before the certificate expiration
date.
However, you will not be notified annually of the continuation of coverage.
NOTICE OF CANCELLATION: THE COMPANY WILL NOT TERMINATE OR REDUCE THE INSURANCE
AFFORDED UNDER THE ABOVE POLICIES UNLESS 30 DAYS NOTICE OF SUCH TERMINATION OR
REDUCTION HAS BEEN MAILED TO:
NATIONAL MEDICAL HEALTH CARE 202
CERTIFICATE SYSTEMS, INC.
HOLDER 00 XXXXXX XXXX XXXXX
XXXX XXXXXXXXXX, XX 00000
LIBERTY MUTUAL GROUP
/s/ Xxxxxxx X. Xxxxxxxxxx
--------------------------
Xxxxxxx X. Xxxxxxxxxx
AUTHORIZED REPRESENTATIVE
08/12/96 (212) 391-7500 New York office
DATE ISSUED TELEPHONE OFFICE
[ILLEGIBLE]
SCHEDULE D
1996 PROCESSING CYCLES
6/8 - 6/21 6/22 - 7/5 7/6 - 7/19 7/20 - 8/2
8/3 - 8/16 8/17 - 8/30 8/31 - 9/13 9/14 -
9/27
9/28 - 10/11 10/12 - 10/25 10/26 - 11/8 11/9 -
11/22 11/23 - 12/6 12/7 - 12/20
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