EXHIBIT 10.3
[*] CERTAIN CONFIDENTIAL INFORMATION
CONTAINED IN THIS DOCUMENT, MARKED BY
BRACKETS, HAS BEEN OMITTED AND FILED
SEPARATELY WITH THE SECURITIES AND EXCHANGE
COMMISSION.
SUPPLY AGREEMENT
This Agreement, effective June 10, 1998, is between Becton Xxxxxxxxx
and Company, having a principal place of business at 0 Xxxxxx Xxxxx, Xxxxxxxx
Xxxxx, XX 00000 ("Supplier") and Coram Healthcare, having offices at Xxxxx 0000,
0000 00xx Xxxxxx, Xxxxxx, Xxxxxxxx 00000 ("Coram") under the terms as set forth
below.
WITNESSETH
Whereas, Supplier is interested in continuing as a supplier of medical
devices and healthcare products and services for Coram; and
Whereas, Supplier is interested in continuing as a preferred supplier
for Coram of such Products; and
Whereas, Coram is interested in continuing to utilize the Products of
Supplier.
NOW, THEREFORE, for mutual consideration, the receipt and sufficiency
of which is acknowledged, the parties agree as follows:
A. SERVICES
1. Products
1. Supplier will provide all Becton Xxxxxxxxx and Company Products but presently
limited to products sold by Becton Xxxxxxxxx Medical, Becton Xxxxxxxxx Consumer
Products, Becton Xxxxxxxxx Infusion Therapy Systems, and Becton Xxxxxxxxx
VACUTAINER Systems. See product lines covered on Attachment A ("Products").
Becton Xxxxxxxxx and Company reserves the right to delete Products from the
scope of this contract which become no longer generally available to the public.
This Agreement applies only to Products listed on Attachment A on the date of
acceptance by Supplier, or such Products at such prices as may be added in the
future by mutual agreement of the parties.
2. Membership
All owned Coram Facilities as described below, listed in Attachment B are
eligible to participate in this Agreement. Coram will provide Supplier with a
Facility List, and represents and warrants that the Facility List is a true and
complete statement of all Facilities in the United States owned, operated, or
effectively managed, whether directly or indirectly, by Coram as of the
Effective Date of this Agreement, and in which Coram uses products of the type
set forth in Attachment A ("Facilities and Facility List").
Coram agrees to notify Supplier in writing and in a timely manner of all changes
in the Facility List during the term of the Agreement. In the event that Coram
adds one or more pharmacy or other healthcare facilities/sites through
acquisition or other arrangement during the course of the contract, upon consent
of Supplier, not to be unnecessarily withheld by Supplier, the volume of Becton
Xxxxxxxxx and Company Products purchased at those new Facilities will be added
to the total base volume of the year of acquisition.
The prices set by this Agreement for Products shall be available to new
Facilities added to the Facility List as of the date of Coram's written notice.
Coram further represents that it, and each of its Facilities, have all Federal,
State and local licenses or permits necessary for their purchase, sale, and/or
distribution and use of Products sold under this Agreement, and will provide
copies of same to Supplier upon its request.
B. COMPENSATION
When buying directly, Coram will pay Supplier within [*] after receipt of
invoice or billing in accordance with the price in effect at the time of the
order minus the discounts reflected herein. When buying indirectly, Coram agrees
to use dealers in good standing and in full compliance with all of Supplier's
credit terms and conditions. All discounts are in consideration of Coram having
selected this supplier as a Preferred Supplier for those Products which it uses
in its Facilities in the United States. Neither Coram nor any third party acting
on its behalf shall export or otherwise transfer outside the United States
Products acquired under this Agreement.
Prices shown on the Attachments (referred to below) are net of brokerage, and
may be amended by the mutual agreement of the parties, shall start at the
Effective Date and shall expire at the end of each respective year of this
Agreement. At the expiration of the [*] of this Agreement, prices for years [*]
for conventional needles and syringes, sharps containers, and InterLink are
subject to a maximum [*] price increase for each contract year unless Coram
exceeds agreed upon minimum utilization levels by [*]. Price for extended dwell
catheters and conventional PVA catheters will increase by a maximum of [*] only
in [*] of this Agreement, provided that the utilization minimums for [*] have
been met. Supplier shall give sixty [*] written notice prior to any additional
price increases. Safety products will not be included in the calculation of
minimums where conventional products are available. BD will track the
cannabalization of conventional product and adjust Coram's conventional volume
accordingly. Price increases on safety products for [*] of the agreement do not
apply. However, should external factors beyond the control of the parties cause
a significant increase or decrease in the pricing of a particular Product or
Products, parties shall negotiate in good faith to reach a mutually agreeable
price for the Product(s).
2
C. CONFIDENTIALITY
Each party shall keep confidential and not disclose to any unauthorized third
party any and all Confidential Information of the other. "Authorized third
parties" shall include appropriate governmental authorities, legal counsel,
financing sources, and business counselors who have executed appropriate
confidentiality agreements. "Confidential Information" shall, without
limitation, consist of trade secrets, know-how, proprietary information,
processes, techniques and information relating to Coram's past, present and
future marketing and research and development activities that are disclosed to
Supplier by Coram and/or Coram's parent, subsidiary or affiliate companies. In
addition, without limiting the foregoing, "Confidential Information" shall also
include any and all information and records Supplier receives in the course of
its performance of its services under this agreement. Notwithstanding the
foregoing, Confidential Information shall not include:
a. Information that is now in the public domain or subsequently enters
the public domain through no fault of the respective party;
b. Information that is presently known or becomes known to a party from
its own independent sources as evidenced by its written records;
c. Information that is received from any third party not under any
obligation to keep such information confidential; or
d. Information independently developed by or for a party hereto by
persons who did not access information disclosed by the other party
under this agreement. Supplier expressly agrees that Supplier shall not
show this Agreement or disclose the existence, nature or subject matter
of this Agreement to any third party without the prior written consent
of Coram. Each party's obligations not to disclose Confidential
Information to third parties and not to otherwise use Confidential
Information shall survive the termination of this Agreement for a
period of three (3) years
D. TERMS OF SALE
Agreements between any of the listed participating Becton Xxxxxxxxx Divisions or
Becton Xxxxxxxxx and Company, and Coram, whether oral or written, are now
superseded by the provisions of this Agreement.
The price and terms of sale (including shipping, delivery and payment terms) for
Products sold through distribution will be in accordance with the designated
distributor's policies. Terms of sale for Becton Xxxxxxxxx Consumer Products
sold on a direct basis are set forth on Attachment E.
3
This contract and related incentives are contingent upon Coram's remaining
committed to a "preferred supplier" award on all core product categories
represented by each participating BDX Division (see attachments C through F).
"Preferred Supplier" is defined for the purposes of this agreement as providing
a [*] of the products identified as Coram Healthcare formulary items, and used
by the Coram Facilities listed on Attachment B, which may be amended from time
to time to reflect the expansion or contraction of Coram's business.
Supplier agrees to [*] Coram the [*] outlined in this document under paragraph
E, and to provide the pricing set forth on Supplier's Attachment to this
Agreement based on Coram's commitment to the following Programs:
1. Becton Xxxxxxxxx Infusion Therapy Systems items defined in
Attachment C
2. Becton Xxxxxxxxx Injection Systems items defined in Attachment D
3. Becton Xxxxxxxxx Consumer Products items defined in Attachment F
4. Becton Xxxxxxxxx Vacutainer Systems items defined in Attachment F
5. Becton Xxxxxxxxx Divisions Value Offerings items defined in
Attachment G
6. Becton Xxxxxxxxx Safety Product offerings, including InterLink,
Safety Glide, Safety Lok, Insyte AutoGuard/Saf-T-Intima, and Safe Blood
Collection as defined in Attachments C, D, F and H
This Agreement includes Products sold by several divisions. Some Products may be
sold on a direct basis. An end-user buying Products sold on a direct basis will
pay the "Direct Price" indicated. Other Products not included on the Attachments
shall be sold at dealer price. Transition to safety products will occur in
accordance with any mandated conversion to use of safety engineered products,
whether by law, regulation, or otherwise.
For purposes of this Agreement, the dollar volume of all Becton Xxxxxxxxx and
Company products will be determined from the contract price, less any returns or
credits on products purchased either direct or from an authorized distributor.
Verification of purchases will be determined from data collected by divisions of
Becton Xxxxxxxxx and Company, Coram, and our authorized distributor(s), and will
be reviewed on a quarterly basis. Supplier shall be the sole arbiter of dollar
volume purchased.
E. BDX ADMINISTRATIVE FEE AND CORAM COMMITMENTS
4
This Agreement between Coram and Becton Xxxxxxxxx and Company will allow for the
following fees to be paid, and prices offered on behalf of all participating
divisions through this Agreement.
At the Effective Date of this Agreement, Supplier [*] Coram an [*] for Coram's
administration of the terms and conditions of this Agreement over its 5 year
term at the [*]. Supplier is offering the pricing for Products and the Value
Offerings in return for Coram's commitment to purchase the minimum quantities of
supplier's Products in each year of this Agreement as set forth in Attachments
C, D, E, F and H (the "Annual Minimum Committed Volumes") subject to the
following terms and conditions:
1. If Coram fails to purchase its Annual Minimum Committed Volume of
any Product Category in any given year of this Agreement after the
first thirteen (13) months of this Agreement as set forth in
Attachments C, D, E and F, Coram shall pay to Supplier a sum equal to
twenty percent (20%) of the contract price, by Product Category as set
forth on Attachments C, D, E and F, for Products not purchased falling
beneath the Annual Minimum Committed Volume (the "Pricing Adjustment").
Coram shall pay the Pricing Adjustment to Supplier within [*] after
Supplier determines the volume purchased by Coram in a given contract
year.
2. If there is a material reduction in the patient population at the
Facilities other than as a result of a sale, divestiture or other
transfer of Coram's business, and upon the request of Coram, Supplier
and Coram agree in good faith to meet and attempt to renegotiate a
modification of Annual Minimum Committed Volumes and other applicable
terms. If Supplier and Coram are unable to agree upon mutually
acceptable terms, Coram may, upon [*] prior written notice to Supplier,
terminate this Agreement in accordance with the provisions of Paragraph
I.2.
3. Coram and Supplier agree to an annual review of minimum committed
volumes on all products. At the end of each contract year, Supplier and
Coram will review Coram's actual purchases of Products as compared with
the Annual Minimum Committed Volumes for such Products during that
contract year. In the event Coram's purchases of a given Product exceed
that year's Annual Minimum Committed Volume for such product category
by more than [*].
5
F. INDEMNIFICATION
Supplier agrees to indemnify Coram and/or its parent, subsidiary and affiliate
companies against any liability (including reasonable attorneys' fees) arising
out of any claim made against them for Supplier's negligence or (a) libel,
slander or defamation, (b) infringement of copyright or other intellectual
property right of any kind whatsoever (excluding infringement by Coram's
products, trademarks, trade names, service marks, etc., of others' patents,
names or marks), (c) piracy, plagiarism or unfair competition or item
misappropriation under implied contract, (d) violation of any Federal, state or
local law, statute, rule or regulation; (e) invasion of rights of privacy to the
extent such liability arises from acts committed by Supplier in any work
prepared for Coram hereunder except that Coram, its parent, subsidiary or
affiliate companies shall be responsible for any such claim arising solely from
Supplier's adherence to Coram's written instructions or directions to the extent
applicable; (f) any claim for damages for personal injury allegedly arising out
of the use of any of Supplier's Products, provided, however, that this
indemnification against personal injury claims shall not apply to Supplier's
Products which have been altered, modified, damaged, opened, or repackaged by
Coram; or (g) or act or omission relating to any modification of Supplier's
systems or processes required to permit such systems or processes to accommodate
data occurring after December 31, 1999.
G. WARRANTY
Supplier warrants to the extent applicable that the Products supplied have been
manufactured or stored in compliance with FDA guidelines, environmental, health
and safety ("EHS") regulations, good manufacturing practices ("GMP") where
applicable and good laboratory practices ("GLP"). Should any Product fail to
perform as intended by Supplier or fail to meet the above warranties, Supplier
shall replace it free of charge. In addition, if any product is proven to fail
to meet FDA guidelines, Supplier will adjust the Annual Minimum Committed Volume
requirement for that product accordingly. This warranty is in lieu of all other
warranties, whether express or implied, including, without limitation,
warranties of merchantability or fitness for a particular use, and shall in no
event apply to any indirect or consequential damages.
H. INSURANCE
Supplier shall maintain at its individual cost and expense, Worker's
Compensation, Comprehensive General Liability and Automobile insurance. Supplier
shall provide reasonable written notice prior to the expiration or cancellation
of such coverage. The amount and extent of such insurance coverage shall not be
less than $1,000,000 per occurrence and $3,000,000 in aggregate. Supplier's
General Liability coverage shall also include product liability endorsement
under which Coram is an additional insured
6
either by being directly named under the policy or through a blanket vendor
endorsement.
I. DURATION OF AGREEMENT
1. Term
This Agreement is effective upon execution and shall continue in full
force and effect for a period of six (6) years provided that, either
party may terminate this Agreement at any time upon at least one
hundred twenty (120) days written notice to the other, sent by
registered mail to the address for the other party first set forth
above, or to such other address which a party may designate for its
receipt of notices hereunder.
2. Termination for Cause
If either party, its affiliates or Facilities fail to meet any
material obligation under this Agreement, then the other party, at its
sole option, and without waiver of any of its rights, may terminate
this Agreement upon thirty (30) days' written notice containing details
of the alleged breach to the breaching party, provided that the breach
remains in effect at the end of the thirty (30) day notice period.
3. Costs Due Upon Early Termination
Upon early termination of this Agreement, whether for cause or
otherwise, Coram shall pay to Supplier an early termination penalty of
[*] for each full unfulfilled contract year (as well as a pro-rated sum
for any part of an unfulfilled contract year), in addition to any other
amounts due and owing to Supplier from Coram, its affiliates,
Facilities, or distributors
J. INDEPENDENT CONTRACTORS
The parties to this Agreement are independent contractors and nothing contained
in this Agreement shall be construed to place the parties in the relationship of
employer and employee, partners, principal and agent, or joint venturers.
Neither party shall have the power to bind or obligate the other party nor shall
either party hold itself out as having such authority.
K. THIRD PARTY OBLIGATIONS
7
Supplier shall make no commitments or disbursements, incur no obligations nor
place any advertising, public relations or promotional material for Coram and/or
Coram's subsidiary or affiliate companies, nor disseminate any material of any
kind using the name of Coram and/or Coram's subsidiary or affiliate companies or
using their trademarks, without the prior written consent of Coram.
L. GOVERNING LAW
This Agreement is entered into in the State of Colorado and shall be construed
and governed under and in accordance with the laws of that State.
M. AUDIT
Supplier reserves the right to conduct audits at reasonable times (but no more
frequently than calendar quarter) of purchases by Coram under this Agreement,
including purchase orders to and invoices from all distributor agents and/or
Becton Xxxxxxxxx divisions. Any such audits shall be conducted during Coram's
normal business hours without causing any unreasonable disruption of Coram's
business operation.
N. SEVERABILITY
If any provision of this Agreement is finally declared or found to be illegal or
unenforceable by a court of competent jurisdiction, both parties shall be
relieved of all obligations arising under such provision, but, if capable of
performance, the remainder of this Agreement shall not be affected by such
declaration or finding.
O. FORCE MAJEURE
Noncompliance with the obligations of this Agreement due to a state of force
majeure, the laws or regulations of any government, regulatory or judicial
authority, war, civil commotion, destruction of facilities and materials, fire,
earthquake or storm, labor disturbances, shortage of materials, failure of
public utilities or common carriers, and any other causes beyond the reasonable
control of the applicable party, shall not constitute a breach of contract.
P. MISCELLANEOUS
1. In recognizing Supplier as a preferred supplier, Coram agrees
to:
a. Encourage participation (e.g. permitting product
exhibition) by the end-user community in selecting
Supplier's products;
8
b. Permit the following:
(i) distribution of product catalog and other
Supplier provided literature;
(ii) periodic vendor shows and technical seminars to
display new products and technical information as may
be agreed upon between Supplier and the individual
sites;
(iii) contractors passes to be provided to Supplier's
personnel.
2. BDX products purchased by Coram covered in this Agreement are "not for
resale", as this may cause such purchases to violate the Xxxxxxxx-Xxxxxx Act.
Xxxxx agrees to inform all responsible individuals in Facilities eligible to
purchase under this Agreement of this requirement.
3. The terms of this Agreement shall bind Coram and Supplier and their
respective successors and assigns. Notwithstanding the foregoing, this Agreement
is not assignable in whole or in part by Supplier without the prior written
consent of Coram, provided, however that Supplier may assign it to any of
Becton's subsidiaries, affiliates, operating units, or other related companies.
Factoring of accounts receivable hereunder is not permitted.
4. In the event that Coram merges with, acquires, or is acquired by a third
party, the terms and conditions of this Agreement shall continue only with the
mutual written consent of Coram and Supplier, which consent shall not be
unreasonably withheld, provided, however, that Supplier shall be provided
information on the new entity, including, without limitation, information
relating to credit policy and product usage, before providing its consent.
5. The failure of either party to take action as a result of a breach of this
Agreement by the other party shall constitute neither a waiver of the particular
breach involved nor a waiver of either party's right to enforce any or all
provisions of this Agreement through any remedy granted by law or this
Agreement.
6. This Agreement contains the entire understanding of the parties with respect
to the subject matter contained herein, supersedes any prior written or oral
communications between the parties relating thereto and may be modified in
writing subject to mutual agreement of the parties hereto.
7. The headings of each paragraph are for reference only and shall not be
construed as part of this Agreement.
9
8. Any offers of gifts or gratuities will not be allowed.
9. All discounts or incentives received by Coram from Supplier
under this Agreement are "Discounts or other reductions in price" to
Purchaser under Section 1128B(b)(3)(A) of the Social Security Act [42
U.S.C. 1320 a-7b(b)(3)(A)]. Coram warrants that it will disclose all
discounts and reductions in price under any State or Federal program
which provides cost or charge based reimbursement to Coram for the
Products and services provided under this Agreement.
10. The parties agree that they must attempt to resolve in good
faith any dispute or claim arising out of or relating to this Agreement
through non-binding mediation before filing suit in any court of
competent jurisdiction.
IN WITNESS WHEREOF, the parties hereto, each by a duly authorized
officer, have entered into this Agreement this 10th day of June, 1998.
CORAM HEALTHCARE BECTON XXXXXXXXX AND COMPANY
By: /s/ XXXXXX XXXXX, XX. By: /s/ XXXXXX XXXXXXX
-------------------------------------- ------------------------------
Title: Senior Vice President Title: President BDHS
---------------------------------- ---------------------------
Date: 1/7/00 Date: 1/10/00
----------------------------------- ----------------------------
(Revised)
10
ATTACHMENT A
CORAM APPROVED PRODUCT FORMULARY FOR BD PRODUCTS
HYPODERMICS
ESTIMATED
PRODUCT DESCRIPTION PRODUCT DEALER LIST ANNUAL CONTRACT
NUMBER PRICE UNITS PRICE
---------------------------- ------- ----------- --------- ---------
20cc Slip Tip 301625
30cc Slip Tip 301626
30ga x 1/2" 305106
27ga x 1/2" RB 305109
25ga x 5/8" RB 305122
25ga x 1" RB 305125
25ga x 1 1/2" RB 305127
21ga x 2" RB 305129
18ga x 1" RBTW 305140
23ga x 1" RB 305145
22ga x 1" RB 305155
21ga x 1" RB 305165
21ga x 1 1/4" RB 305166
21ga x 1 1/2" RB 305167
20ga x 1" RB 305175
20ga x 1 1/2" RB 305176
19ga x 1 1/2" MTW 305187
21ga x 1 1/2" XX XX 305190
18ga x 1" RB 305195
18ga x 1 1/2" RW 305196
16ga x 1" RB 305197
16ga x 1 1/2" RB 305198
19ga x 1 1/2" TW 305200
18ga x 1 1/2" TW 5 305201
15cc Tamper-Tuf Assembled 305203
30cc Tamper-Tuf Assembled 305204
15cc Tamper-Tuf Unassembled 305205
30cc Tamper-Tuf Unassembled 305206
1 ml amber 305207
5 ml amber 305208
10 ml amber 305209
3 ml Amber 305210
18ga x 1" TW 305214
18ga x 1 1/2" MTW 305215
16ga x 1" MTW 305216
1 ml clear 305217
5 ml clear 305218
10 ml clear 305219
3 ml Clear 305220
Bottle Adapter 305222
Filling Connector 305223
Disposable Syringe System 305224
Syringe Tip Connector 305225
..45 Micron 305230
..20 Micron 305231
2 1/2cc 10/Tray 305257
19ga x 1" 305285
ATTACHMENT A
CORAM APPROVED PRODUCT FORMULARY FOR BD PRODUCTS
HYPODERMICS
-----------------------------------------------------------------------------------------------
Estimated
Product Description Product Dealer List Price Annual Contract
Number Units Price
-----------------------------------------------------------------------------------------------
2 1/2cc 305291
1cc Tuberculin Type 305292
5cc 305293
10cc 305294
3cc 25ga x 1" MedSaver 305591
3cc 25ga x 5/8" MedSaver 305592
3cc 22ga x 1 1/2" MedSaver 305593
3cc 23ga x 1" MedSaver 305595
1cc 25ga x 5/8" MedSaver 305605
20cc LL 305617
30cc LL 305618
Tip Cap Tray 308341
3cc 25ga x 5/8" Slip Tip 309541
25ga x 5/8" 309570
23ga x 1" 309571
22ga x 1" 309572
22ga x 1 1/2" 309574
21ga x 1" 309575
21ga x 1 1/2" 309577
20ga x 1" 309578
25ga x 1" 309581
25ga x 1 1/2" 309582
26ga x 5/8" 309597
1cc Slip Tip 309602
5cc LL 309603
10cc LL 309604
10cc 309605
1cc 22ga x 1" 309621
1cc 27ga x 1/2" 309623
1cc 21ga x 1" 309624
1 ml 25ga x 5/8" 309626
1 ml LL 1/100 ml 309628
5cc 22ga x 1" 309630
5cc 22ga x 1 1/2" 309631
5cc 21ga x 1" 309632
5cc 20ga x 1" 309634
5cc 20ga x 1 1/2" 309635
10cc 21ga x 1" 309642
10cc 20ga x 1" 309644
60cc 309660
20cc Syr. LL 309661
30cc Syr. LL 309662
2 oz. Catheter Tip 309664
5cc 23ga x 1" RB 309669
60cc LL 309680
1/2cc 29ga x 1/2" 309306
1cc 28ga x 1/2" 309309
ATTACHMENT A
CORAM APPROVED PRODUCT FORMULARY FOR BD PRODUCTS
HYPODERMICS
-------------------------------------------------------------------------------------------
Estimated
Product Description Product Dealer List Price Annual Contract
Number Units Price
-------------------------------------------------------------------------------------------
1cc 27ga x 5/8" 309310
1cc 29ga x 1/2" 309311
1cc S/C 28ga x 5/8" 329410
1cc 29ga x 1/2" ultra fine 329411
1cc S/C 27ga x 5/8" 329412
1cc 28ga S/U Scale Blister Pkg 329420
1cc 28ga x 1/2" Blister Pkg 329424
3/10cc 28ga x 1/2" S/C 329430
3/10cc 29ga x 1/2" S/C 329431
1/2cc 28ga x 1/2" Blister Pkg 329461
1/2cc 28ga x 1/2" S/C 329466
1/2cc 28ga x 1/2" S/C 329466
2cc 27ga x 5/8" Blister Pkg 329485
1cc 25ga x 1" 329622
1cc Insulin Only Slip Tip 329650
ATTACHMENT A
CORAM APPROVED PRODUCT FORMULARY FOR BD PRODUCTS
SHARPS COLLECTORS
Product Dealer List Estimated Contract
Product Description Number Price Annual Units Price
------------------- ------- ----------- ------------ --------
6 gal Security - Large 5495
3.2 qt Vertical entry - Clear 300448
6.9 qt - Medium, Non-Vented 300467
8.2 qt - Large, Non-Vented 300470
5 gal - X-Large, Open Top, Non-Vent 300473
5.4 qt - Side Entry, Pearl 305425
5.4 qt - Horizontal, Red 305426
5.4 qt - Horizontal, Clear 305427
5.4 qt - Horizontal, Pearl 305428
5.4 qt - Side Entry, Clear 305429
10 Gal - Nestable 305437
18 Gal - Nestable 305438
5.4 qt - Side Entry, Clear 305439
16 gal 305440
16 gal - White 305441
16 gal - Base Stand 305442
5.4 qt - Side Entry, Red 305443
5.4 qt - Side Entry, Pearl 305444
5.4 qt - Horizontal, Red 305445
5.4 qt - Horizontal, Clear 305446
5.4 qt - Locking Wall Bracket 305447
5.4 qt - Horizontal, Pearl 305452
6 gal - Clear Top, Open 305457
Nestable 8 qt - Clear Top, Red 305460
8 qt - Clear Top, Pearl 305463
14 qt - Clear Top, 60cc Funnel 305464
6 gal - Clear Top, Large Funnel 305465
3.2 qt - Vertical Entry, Clear 305469
3.2 qt - Vertical Entry, Red 305471
3.2 qt - Vertical Entry Wall Cabinet 305475
5 gal - X-Large, Large Funnel 305477
8 qt - Red 305479
14 qt - Clear Top, Large Funnel 305480
6 gal - Open Top 305481
Nestable Brackets for 8 qt, 14 qt, 6 gal 305485
1.4 qt - Tray Size 305487
3.3 qt - Small 305488
6.9 qt - Medium 305489
8.2 qt - Large 305490
5 gal - X-Large, Open Top 305491
9.2 qt Chemo Coll. - White 305492
19.7 qt (5gal) - X-Large Chemo Coll 305493
Security Lock / PadLock 305494
5 gal Bracket 305495
6.9 qt thru 9.2 qt - Bracket 305496
3.3 qt thru 5 gal - Quick Release Strap 305497
1.0 qt Phlebotomy 305512
ATTACHMENT A
CORAM APPROVED PRODUCT FORMULARY FOR BD PRODUCTS
SHARPS COLLECTORS
Product Dealer List Estimated Contract
Product Description Number Price Annual Units Price
------------------------- ------- ----------- ------------ --------
1.8 qt. Safety Cradle, Pearle 305514
3.1 qt. Safety Cradle, Pearle 305515
5.3 qt. Safety Cradle, Pearle 305516
ATTACHMENT A
CORAM APPROVED PRODUCT FORMULARY FOR BD PRODUCTS
INTERLINK
PRODUCT DEALER LIST ESTIMATED CONTRACT
PRODUCT DESCRIPTION NUMBER PRICE ANNUAL UNITS PRICE
------------------- ------ ----- ------------ -----
3cc Syringe with Cannula 303400
3cc Syringe with Vial Access Cannula 303401
5cc Syringe with Xxxxxxx 000000
5cc Syringe with Vial Access Cannula 303403
10cc Syringe with Cannula 303404
10cc Syr. with Vial Access Cannula 303405
Syringe Cannula (Bare Cannula) 003366
Syringe Cannula (Bare Cannula) 303366
Vial Access Cannula 303367
Threaded Lock Cannula 303369
Lever Lock Cannula 303370
Vacutainer holder w/ syr cannula 303381
ATTACHMENT A
CORAM APPROVED PRODUCT FORMULARY FOR BD PRODUCTS
THERMOMETRY
Product Dealer List Estimated Contract
Product Description Number Price Annual Units Price
-------------------------------------------------------------------------------------------------
Temp-Away - Rectal 003701
20TT Box with Therm 300/cs 003702
20RT Box with Therm 300/cs 003704
20T Box without Therm 300/cs 003705
20TT Box without Therm 100/cs 003706
20RT Box without Therm 100/cs 003707
Temp-Away - Oral, 5000 ea. loose 003714
Temp-Away - Oral, w/ACC 1000 ea. 003715
Temp-Away - RS, 1000 ea. loose 003734
20TT Box with Celsius Therm 300/cs 003743
20RT Box with Celsius Therm 300/cs 003747
Temp-Away - Rectal, 5000 ea. loose 003752
Temp-Away - Oral 003700
---------------------------------------------------------------------------------------------------
ATTACHMENT A
CORAM APPROVED PRODUCT FORMULARY FOR BD PRODUCTS
BD INFUSION THERAPY - PERIPHERAL VASCULAR ACCESS
Product Dealer List Estimated Contract
Product Description Number Price Annual Units Price
Insyte 22ga x 1" 381123
Insyte-N 24 x 9/16" 381211
Insyte 24ga x 3/4" 381212
Insyte 20ga x 1" 381233
Insyte 20x 1 1/4" 381234
Insyte 20ga x 2" 381237
Insyte 18ga x 1 1/4" 381244
Insyte 18ga x 2" 381247
Insyte-N 24ga x 9/16" Winged 381311
Insyte-W 24ga x 3/4 " 381312
Insyte-W 22ga x 1" 381323
Insyte-W 20ga x 1" 381333
Insyte-W 20x 1 1/4" 381334
Insyte-W 20ga x 2" 381337
Insyte-W 18ga x 1 1/4" 381344
Insyte-W 18ga x 2" 381357
Insyte-W 16ga x 1 1/4" 381354
Insyte-W 16ga x 2" 381357
AutoGuard 24ga x 3/4" 381412
AutoGuard 22ga x 1" 381423
AutoGuard 20ga x 1" 381433
AutoGuard 20x 1 1/4" 381434
AutoGuard 20ga x 2" 381437
AutoGuard 18ga x 1 1/4" 381444
AutoGuard 18ga x 2" 381447
AutoGuard 16ga x 1 1/4" 381454
AutoGuard 16ga x 2" 381457
AutoGuard 14ga x 2" 381467
20ga x 1 1/4" 386181
E-Z Set 25ga x 1/2" 387223
E-Z Set 23ga x 3/4" 387234
E-Z Set 23ga x 3/4" 387236
Sat-T E-Z Set 27ga x 3/8" 387312
Sat-T E-Z Set 23ga x 3/4" 387336
E-Z Set 25ga x 3/4" 387726
J-Loop 3812522
20ga x 2" 3829581
20ga x 1 1/4" 3829591
22ga x 1" 3829621
24ga x 3/4" 3829641
20ga x 1" 3861201
22ga x 3/4" 3861221
Intima 24ga x 3/4" 3863241
20ga x 1" Y-Set 3864201
22ga x 3/4" Y-Set 3864221
Sat-T Intima 24ga x 3/4" PRN 3877241
ATTACHMENT A
CORAM APPROVAL PRODUCT FORMULARY FOR BD PRODUCTS
BD INFUSION THERAPY -- SITE MAINTENANCE
Product Dealer List Estimated Contract
Product Description Number Price Annual Units Price*
------------------------- ------- ----------- ------------ --------
IV Start Pack 386140
2-2x2" Gauze Sponges
1-Povidone Iodine Prep
1-Tourniquet
1-Roll Plastic Tape
1-I.D. label
1-Tegaderm (3M#1620)
2 Alcohol Pads
Dressing Change Tray* 386500
Current contract kit has been
discontinued. Net kit
componentry and price to be
determined
IV Start Pack with Persist,
Tegaderm 386149
2-2x2" Gauze Sponges
1-Povidone Iodine Prep
1-Tourniquet
1-Roll Plastic Tape
1-Drape
1-I.D. label
1-Tegaderm (3M#1620)
2 Alcohol Pads
* Coram agrees that effective 9/30/98 that all kit volume will be
supplied by BD. Components will be determined by Coram and Price
will be established by BD.
ATTACHMENT A
CORAM APPROVED PRODUCT FORMULARY FOR BD PRODUCTS
BD INFUSION THERAPY - EXTENDED DWELL CATHETERS
PRODUCT DEALER LIST ESTIMATED CONTRACT
PRODUCT DESCRIPTION NUMBER PRICE ANNUAL UNITS PRICE
------------------- ------- ----------- ------------ --------
1.9fr introducer INtroSYTE 384021
3 french Introducer - INtroSYTE 384030
2.8fr introducer INtroSYTE 384031
4 french Introducer - INtroSYTE 384040
5 french Introducer - INtroSYTE 384050
3fr x 65cm First PICC Mini-Kit 384131
3fr x 65cm First PICC Procedural Kit 384134
4fr x 65cm First PICC Mini kit 384141
4fr x 65cm First PICC Procedural Kit 384144
5fr x 65cm First PICC Mini kit 384151
5fr x 65cm First PICC Dual Lumen Mini-Kit 384152
5fr x 65cm First PICC Procedural Kit 384154
5fr x 65cm First PICC D/L Procedural-Kit 384155
1.9fr x 20cm first MidCath Procedural-Kit 384224
2.8fr x 20cm first MidCath Procedural-Kit 384234
3fr x 20cm first MidCath Mini-Kit 384331
3fr x 20cm first MidCath Procedural-Kit 384334
4fr x 20cm first MidCarth Mini-Kit 384341
4fr x 20cm first MidCath Procedural-Kit 384344
5fr x 20cm first MidCarth Mini-Kit 384351
5fr x 20cm first MidCath D/L Mini-Kit 384352
5fr x 20cm first MidCath Procedural-Kit 384354
5fr x 20cm first MidCath D/L Procedural-Kit 384355
ATTACHMENT A
CORAM APPROVED PRODUCT FORMULARY FOR BD PRODUCTS
BD CONSUMER
Estimated
Product Dealer List Annual Contract Price
Product Description Number Price Units Year 1 Year 2 Year 3 Year 4 Year 5
Ultra-fine Lancets 200's 325772
1cc 25gs x 5/8" 329651
1cc 26ga x 1/2" 329652
1cc 26ga x 1/2" 329653
ATTACHMENT B
------------------------------------------------------------------------------------------------------------------------------------
BRANCH ADDRESS AND PHONE TYPE OF LICENSE LICENSE # REMIT TO
------------------------------------------------------------------------------------------------------------------------------------
Birmingham, AL CHC of Alabama DEA Registration [*] X.X. Xxx 00000
000 Xxxxx Xxxxx Xxxxxxxx Xxxx, $ 435 Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-1231
(000) 000-0000 National Association Boards of Pharmacy [*]
(000) 000-0000 fax Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Montgomery, AL CHC of Alabama Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
1736 West Second Street, Ste A Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-1231
(000) 000-0000
(000) 000-0000 fax
------------------------------------------------------------------------------------------------------------------------------------
Phoenix, AZ Coram Alternate Site Services Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
0000 Xxxx Xxxxx Xxxxxx DEA Registration [*] Chicago, IL
Xxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Tucson, AZ Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 X. Xxxx Xxxxx, #205 Federal Tax ID Number [*] Chicago, IL
Xxxxxx, XX 00000 Home Health Agency License [*] 60694-1805
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part A [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Bakersfield, CA Xxxx Home Health DEA Registration [*] X.X. Xxx 00000
Partnership d/b/a Coram Healthcare Federal Tax ID Number [*] Chicago, IL
0000 Xxxxxxx Xxxxxx, #000 Home Health Agency License [*] 60694-1881
Xxxxxxxxxxx, XX 00000 JCAHO Accreditation [*]
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Resident State Controlled Substance [*]
------------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT B
Glendale, CA CHC of Southern California Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
0000 Xxxxx Xxxxxxx Xxxxxx DEA Registration [*] Chicago, IL
Xxxxxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Controlled Substance [*]
State Wholesale Pharmacy Permit [*]
San Francisco, CA CHC of Northern California Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
00000 Xxxxx Xxxxxxxxx DEA Registration [*] Chicago, IL
Xxxxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 JCAHO Accreditation [*]
Medicare - Part A [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Controlled Substance [*]
State Wholesale Pharmacy Permit [*]
Ontario, CA CHC of Southern California Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
0000 X. Xxxxxx Xxxxxx, Xxx X DEA Registration [*] Chicago, IL
Xxxxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Sacramento, CA Coram Homecare of N. CA Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
Nursing Only 0000 Xxxxxxx Xxxx, Xxx X Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxxx, XX 00000 Home Health Agency License [*] 60694-4798
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part A [*]
[*]
Sacramento, CA CHC of Northern CA DEA Registration [*] X.X. Xxx 00000
Pharmacy Only 0000 Xxxxxxx Xxxx, Xxx X Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4798
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
[*]
ATTACHMENT B
San Diego, CA Coram Alternate Site Service Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
0000 Xxxxxx Xxxxxx DEA Registration [*] Xxxxxxx, XX
Xxx Xxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare-Part B [*]
Medicare-Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Santa Barbara, CA CHC of Southern California Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
000 Xxxx Xxxxxxxx, Xxx 000-X Federal Tax ID Number [*] Xxxxxxx, XX
Xxxxx Xxxxxxx, XX 00000 Home Health Agency License [*] 60694-4790
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax
Tustin, CA CHC of Southern California DEA Registration [*] X.X. Xxx 00000
00000 Xxxxxxx Xxxx, Xxxx X Federal Tax ID Number [*] Chicago, IL
Xxxxxx, XX 00000 National Association Boards of Pharmacy [*] 60694-4790
(000) 000-0000 Resident State Pharmacy Permit [*]
(000) 000-0000 fax
Denver, CO Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
7042 X. Xxxxxx Parkway, #490 Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4805
(000) 000-0000 Medicare-Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
Wallingford, CT Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0 Xxxxxx Xxxxxxxxxx Xxxx Xxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4852
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Washington, D.C. CHC of Greater D.C. Federal Tax ID Number [*] X.X. Xxx 00000
0000 X Xxxxxx XX, Xxxxx 000 Xxxxxxx, XX
Washington, D.C. 20037 60694-4780
Milford, XX Xxxxx Alternative Site Services Federal Tax ID Number [*] X.X. Xxx 00000
Xxxxxxxx Xxxx, Xxxxx 000 J Chicago, IL
Xxxxxxx, XX 00000 60694-4775
(000) 000-0000
(000) 000-0000 fax
Orlando, FL Coram Alternative Site Services DEA Registration [*] X.X. Xxx 00000
000 X. Xxxxxxxxx Xxxx, #0000 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxxx Xxxxxxx, XX 00000 Home Health Agency [*] 60694-4803
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Boca Raton, FL CHC of Southern Florida Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
000 Xxxxx Xxxxx Xxxx, #000 DEA Registration [*] Chicago, IL
Xxxx Xxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Jacksonville, FL Coram Alternative Site Services DEA Registration [*] X.X. Xxx 00000
0000 Xxxxxxxx Xxxxxxx, #000 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxxxxxx, XX 00000 Home Health Agency [*] 60694-4803
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
Miami, FL CHC of Southern Florida DEA Registration [*] X.X. Xxx 00000
0000 X.X. 00xx Xxxxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxx, XX 00000 Home Health Agency [*] 60694-4781
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Sarasota, FL CHC of Florida DEA Registration [*] X.X. Xxx 00000
0000 Xxxxxx Xxxx Xxxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxx, XX 00000 Home Health Agency [*] 60694-4803
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Tampa, FL CHC of Florida Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
0000 Xxxxxxxx Xxxx, #000 DEA Registration [*] Chicago, IL
Xxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Athens, GA Coram Alternate Site Services Federal Tax ID Number [*] X.X. Xxx 00000
000 Xxxxxx Xxxxx, Xxxx 00 Home Health Agency [*] Chicago, IL
Xxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4777
(000) 000-0000
(000) 000-0000 fax
Atlanta, GA Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 Xxxxxxxxx Xxxx, #000 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxx, XX 00000 Home Health Agency [*] 60694-4777
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
------------------------------------------------------------------------------------------------------------------------------------
Honolulu, HI Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
00-000 Xxxx Xxxxxx Federal Tax ID Number [*] Chicago, IL
Xxxxxxx, XX 00000-0000 JGAHO accreditation [*] 60694-4805
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 National Association Boards of Pharmacy [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Boise, ID Coram Alternate Site Services Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
0000 Xxxxxxx Xxxxxx DEA Registration [*] Chicago, IL
Xxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Chicago, IL Coram Alternate Site Services Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
Pharmacy Only 0000 Xxxxxxxx Xxxxxx Xx, #000 DEA Registration [*] Chicago, IL
Xx. Xxxxxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Chicago, IL Coram Homecare of Illinois Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
Nursing Only 0000 Xxxxxxxx Xxxxxx Xx, #000 Xxxxxxx Tax ID Number [*] Chicago, IL
Xx. Xxxxxxxx, XX 00000 Home Health Agency License [*] 60694-4838
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part A [*]
------------------------------------------------------------------------------------------------------------------------------------
Chicago, IL ABC Infusion Therapy Federal Tax ID Number [*] X.X. Xxx 00000
Partnership 0000 Xxxxxxxx Xxxxxx Xx, #000 Medicare - Part B [*] Chicago, IL
Xx. Xxxxxxxx, XX 00000 60694-4897
(000) 000-0000
(000) 000-0000 fax
------------------------------------------------------------------------------------------------------------------------------------
Chicago, IL Hindsale Infusion Care Federal Tax ID Number [*] X.X. Xxx 00000
Partnership 0000 Xxxxxxxx Xxxxxx Xx, #000 Medicare - Part B [*] Chicago, IL
Xx. Xxxxxxxx, XX 00000 60694-4876
(000) 000-0000
(000) 000-0000 fax
------------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT B
------------------------------------------------------------------------------------------------------------------------------------
Fort Xxxxx, IN Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
000 Xxxxxxxx Xxxxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Ft. Xxxxx, XX 00000 Home Health Agency License [*] 60694-4825
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Indianapolis, IN Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
7114 Lakeview Pkwy W Dr., #111 Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxxxxx, XX 00000 Home Health Agency License [*] 60694-4825
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Indianapolis, IN HealthOptions, LLC Federal Tax ID Number [*] X.X. Xxx 00000
Partnership 0000 Xxxxxxxx Xxxx X Xx., #000 Xxxxxxx, XX
Xxxxxxxxxxxx, XX 00000 60694-4825
(000) 000-0000
(000) 000-0000 fax
------------------------------------------------------------------------------------------------------------------------------------
Merrilville, IN CHC of Indiana Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
000 Xxxx 00xx Xxxxxx DEA Registration [*] Chicago, IL
Xxxxxxxxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT B
Quad Cities, IA Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 X. 00xx Xxxxxx Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4820
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of [*]
Pharmacy
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
----------------------------------------------------------------------------------------------------------------------------------
Quad Cities, IA Covenant Home Infusion Federal Tax ID Number [*] X.X. Xxx 00000
Partnership 0000 X. 00xx Xxxxxx Medicare - Part B [*] Chicago, IL
Xxxxxxxxx, XX 00000 60694-4873
(000) 000-0000
(000) 000-0000 fax
----------------------------------------------------------------------------------------------------------------------------------
Quad Cities, IA Trinity Home Infusion Federal Tax ID Number [*] X.X. Xxx 00000
Partnership 0000 X. 00xx Xxxxxx Medicare - Part B [*] Chicago, IL
Xxxxxxxxx, XX 00000 60694-4892
(000) 000-0000
(000) 000-0000 fax
----------------------------------------------------------------------------------------------------------------------------------
Kansas City, KS Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 Xxxxx Xxxxxxx Tax ID Number [*] Chicago, XX
Xxxxxx, XX 00000 Home Health Agency License [*] 60694-5984
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part A [*]
Medicare - Part B [*]
National Association Boards of [*]
Pharmacy
Non-Resident Home Health Agency [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
----------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT B
------------------------------------------------------------------------------------------------------------------------------------
Witchita, KS Coram Alternate Site Services Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
0000 X. Xxxx, #000 DEA Registration [*] Chicago, IL
Xxxxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Wichita, KS Total Homecare Infusion Federal Tax ID Number [*] X.X. Xxx 00000
Partnership 0000 X. Xxxx, #000 Medicare - Part B [*] Chicago, IL
Xxxxxxx, XX 00000 60694-4816
(000) 000-0000
(000) 000-0000 fax
------------------------------------------------------------------------------------------------------------------------------------
Covington, KY CHC of Kentucky Clinical Lab Improvement Waiver Cert. [*]
00 X. Xxxxx Xxxxxx Xxxx, #000 Xxxxxxx Tax ID Number [*]
Xxxxxxxxx, XX 00000 Home Health Agency License [*]
JCAHO Accreditation [*]
------------------------------------------------------------------------------------------------------------------------------------
Lafayette, LA Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
118 Toledo Drive Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-1265
(000) 000-0000 Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT B
New Orleans, LA Coram Alternate Site Services DEA Registration [*] P.O. Box 71265
Westside One, #100 Federal Tax ID Number [*] Chicago, IL
000 Xxxxx Xxxxx Xxxx Home Health Agency License [*] 60694-1265
Xx. Xxxx, XX 00000 JCAHO Accreditation [*]
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
Baltimore, MD CHC of Greater D.C. DEA Registration [*] X.X. Xxx 00000
000 X. Xxxxx Xx., 0xx Xxxxx, #000 Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxx, XX 00000 Resident State Controlled Substance [*] 60694-4780
(000) 000-0000 Resident State Pharmacy Permit [*]
(000) 000-0000 fax
Columbia, MD CHC of Greater D.C. DEA Registration [*] X.X. Xxx 00000
7150 Columbia Gateway Dr, Ste C Federal Tax ID Number [*] Chicago, IL
Xxxxxxxx XX 00000 JCAHO Accreditation [*] 60694-4780
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Residential Service Agency [*]
Hopkinton, MA CHC of Massachusetts DEA Registration [*] X.X. Xxx 00000
000 Xxxxx Xxxxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4822
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
Grand Rapids, MI Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 0xx Xxxxxx, #000 Xxxxxxx Xxx XX Number [*] Chicago, IL
Xxxxx Xxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4766
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Lansing, MI CHC of Michigan DEA Registration [*] X.X. Xxx 00000
5918 Enterprise Drive Federal Tax ID Number [*] Xxxxxxx, XX
Xxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4766
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Detroit, MI Coram Alternate Site Services Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
00000 Mast DEA Registration [*] Chicago, IL
Xxxxxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part A [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Minneapolis, MN Coram Homecare of MN Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
Nursing Only 0000 Xxxxxxx Xxxxxxx Xxxx, #000 Federal Tax ID Number [*] Chicago, IL
Xxxxxxx Xxxxxxx, XX 00000 Home Health Agency License [*] 60694-3163
(000) 000-0000 Hospice [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part A [*]
ATTACHMENT B
------------------------------------------------------------------------------------------------------------------------------------
Minneapolis, MN Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
Pharmacy Only 0000 Xxxxxxx Xxxxxxx Xxxx, #000 Federal Tax ID Number [*] Chicago, IL
Xxxxxxx Xxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-3163
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
State Wholesale Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Jackson, MS CHC of Mississippi DEA of Registration [*] X.X. Xxx 00000
#0 Xxx Xxxxx Xxxxx, Xxx X Federal Tax ID Number [*] Chicago, IL
Xxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-1265
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
Meridian, MS CHC of Mississippi Federal Tax ID Number [*] X.X. Xxx 00000
0000 00xx Xxxxxx, #0 Xxxxxxx, XX
Xxxxxxxx, XX 00000 60694-1265
(000) 000-0000
(000) 000-0000 fax
-------------------------------------------------------------------------------------------------------------------------------
St. Louis, MO Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
1842 Lackland Hill Parkway Federal Tax ID Number [*] Xxxxxxx, XX
Xx. Xxxxx, XX 00000 Home Health Agency License [*] 60694-4847
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part A [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
-------------------------------------------------------------------------------------------------------------------------------
Omaha, NE Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 X 000xx Xxxxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxx, XX 00000 Home Health Agency License [*] 60694-4841
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part A [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
Omaha, NE Coram Prescription Services DEA Registration [*] X.X. Xxx 00000
0000 X Xxxxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxx, XX 00000 Medicare - Part B [*] 60694-1505
(000) 000-0000 National Association Boards of Pharmacy [*]
(000) 000-0000 fax Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
ATTACHMENT B
------------------------------------------------------------------------------------------------------------------------------------
Omaha, NE Coram Prescription Services, Non-Resident State Pharmacy Permit [*]
continued Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Carson City, NV CHC of Nevada DEA Registration [*] X.X. Xxx 00000
000 Xxxxxx Xxxx, #000 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxx Xxxx, XX 00000 JCAHO Accreditation [*] 60694-1360
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Las Vegas, NV CHC of Nevada DEA Registration [*] X.X. Xxx 00000
000 X. Xxxxx Xxxx. #101-105 Federal Tax ID Number [*] Chicago, IL
Xxx Xxxxx, XX 00000 JCAHO Accreditation [*] 60694-4773
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Nursing Pool [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Reno, NV CHC of Nevada DEA Registration [*] X.X. Xxx 00000
1050 Bible Way Federal Tax ID Number [*] Chicago, IL
Xxxx, XX 00000 JCAHO Accreditation [*] 60694-1360
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Nursing Pool [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Bedford, NH CHC of New Hampshire DEA Registration [*] X.X. Xxx 00000
9 Cedarwood Drive, #3 Federal Tax ID Number [*] Chicago, IL
Xxxxxxx, XX 00000 Home Health Agency License [*] 60694-4822
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT X
Xx. Xxxxxx, XX Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
000 Xxxxxxxxxx Xxxx, #000 Xxxxxxx Tax ID Number [*] Chicago, IL
Xx. Xxxxxx, XX 00000 Health Care Service Firm [*] 60694-4775
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Controlled Substance [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Totowa, NJ Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
11 H Commerce Way Federal Tax ID Number [*] Chicago, IL
Xxxxxx, XX 00000 Health Care Service Firm [*] 60694-4849
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Albuquerque, NM Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 XxXxxx X.X., Xxx X Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4805
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Buffalo, NY CHC of New York DEA Registration [*] X.X. Xxx 00000
000 X. Xxxxxx Xxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxx, XX 00000 Home Health Agency License [*] 60694-4807
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Syracuse, NY CHC of Greater New York DEA Registration [*] X.X. Xxx 00000
00 Xxxxxxxxx Xxxxxx Xxxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxx Xxxxxxxx, XX 00000 Home Health Agency License [*] 60694-4807
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
Albany, NY CHC of New York DEA Registration [*] X.X. Xxx 00000
0 Xxxxxxx Xxxxxxxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxxxxx, XX 00000 Home Health Agency License [*] 60694-4807
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
New York, NY CHC of Greater NY Federal Tax ID Number [*] X.X. Xxx 00000
Nursing Only 00 Xxxx 00xx Xxxxxx Home Health Agency License [*] Xxxxxxx, XX
Xxx Xxxx, XX 00000 JCAHO Accreditation [*] 60694-4849
(000) 000-0000
Xxxx Xxxxxx, XX XXX xx Xxxxxxx XX DEA Registration [*] X.X. Xxx 00000
45 S. Service Road Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxx, XX 00000 Home Health Agency License [*] 60694-4849
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Asheville, NC Coram Alternative Site Services Clinical Lab Improvement Waiver Cert [*] X.X. Xxx 00000
0 Xxxxxxxxx Xxxx, Xxx X-0 DEA Registration [*] Chicago, IL
Xxxxxxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Charlotte, NC Coram Alternative Site Services Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
0000-X Xxxxxxxx Xxxx Xxxx DEA Registration [*] Chicago, IL
Xxxxxxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
Raleigh, NC Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 Xxxxxxxxx Xxxx Xxxxx,#000 Federal Tax ID Number [*] Xxxxxxx, XX
Xxxxxxxxxxx,XX 00000 Home Health Agency License [*] 60694-4784
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
Winston-Salem, NC Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 Xxxxxxxxx Xxxx, Xxx X Federal Tax ID Number [*] Chicago, IL
Xxxxxxx-Xxxxx, XX 00000 Home Health Agency License [*] 60694-4803
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
Cincinnati, OH Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
53 Circle Freeway Drive Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4816
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Cleveland, OH Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
4350 Xxxxx Industrial Pkwy, Ste P Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxxxxx Xxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4816
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
State Wholesale Pharmacy Permit [*]
Cleveland, OH HCM Healthcare Infusion Services DEA Registration [*] X.X. Xxx 00000
4350 Xxxxx Industrial Pkwy, Ste P Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxxxxx Xxxxxxx, XX 00000 Resident State Pharmacy Permit [*] 60694-1803
(000) 000-0000
(000) 000-0000 fax
ATTACHMENT B
Columbus, OH Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
000 Xxxxxxxxxx Xxxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxxxxx, XX 00000-0000 JCAHO Accreditation [*] 60694-4816
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
Oklahoma City, OK Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 X.X. 0xx Xxxxxx, #000 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxx Xxxx, XX 00000 Home Health Agency License [*] 60694-4788
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Tulsa, OK Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 X 000xx X. Xxxxxx, #000 Xxxxxxx Xxx XX Number [*] Chicago, IL
Xxxxx, XX 00000 Home Health Agency License [*] 60694-4788
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Portland, OR Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
7358 X.X. Xxxxxx Road Federal Tax ID Number [*] Chicago, IL
Xxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4805
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident Home Health Agency [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
----------------------------------------------------------------------------------------------------------------------------------
Pittsburgh, PA Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
000 Xxxxxxxxx Xxxxx, #000 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxxx Xxxxxxxx, XX 00000 Home Health Agency License [*] 60694-4792
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of [*]
Pharmacy
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
State Wholesale Pharmacy Permit [*]
State Wholesale Pharmacy Permit [*]
----------------------------------------------------------------------------------------------------------------------------------
Harrisburg, PA Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 Xxxxx Xxxxx, #000 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxxxx, XX 00000 Home Health Agency License [*] 60694-4775
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of [*]
Pharmacy
Resident State Pharmacy Permit [*]
----------------------------------------------------------------------------------------------------------------------------------
Philadelphia, PA Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
6 Spring Mill Drive Federal Tax ID Number [*] Chicago, IL
Xxxxxxx, XX 00000 Home Health Agency License [*] 60694-4775
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part A [*]
Medicare - Part B [*]
National Association Boards of [*]
Pharmacy
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
----------------------------------------------------------------------------------------------------------------------------------
Warwick, RI CHC of Rhode Island DEA Registration [*] X.X. Xxx 00000
20 Xxxxxxx Way, Unit 1 Federal Tax ID Number [*] Chicago, IL
Xxxxxxx, XX 00000-0000 JCAHO Accreditation [*] 60694-4822
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of [*]
Pharmacy
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
----------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT B
Charleston, SC CHC of South Carolina DEA Registration [*] X.X. Xxx 00000
0000 Xxxxxx Xxxx, Xxx 000XX Federal Tax ID Number [*] Chicago, IL
Xxxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4768
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident Controlled Substance [*]
Resident State Pharmacy Permit [*]
Columbia, SC Carolina Home Therapeutics DEA Registration [*] X.X. Xxx 00000
Partnership 000 Xxxxxxx Xxxx, #000 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxx, XX 00000 Home Health Agency License [*] 60694-4777
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident Controlled Substance [*]
Resident State Pharmacy Permit [*]
Greenville, SC Coram Homecare of SC Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
Nursing Only 0000 Xxxxxxxx Xxxx, Xxx X-00 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxxxx, XX 00000 Home Health Agency License [*] 60694-4768
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part A [*]
Greenville, SC CHC of South Carolina DEA Registration [*] X.X. Xxx 00000
Pharmacy Only 0000 Xxxxxxxx Xxxx, Xxx X-00 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4768
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident Controlled Substance [*]
Resident State Pharmacy Permit [*]
Johnson City, TN Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 Xxxx Xxxxxx Xxxxxxx Tax ID Number [*] Xxxxxxx, XX
Xxxxxxx Xxxx, XX 00000 JCAHO Accreditation [*] 60694-4777
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
Memphis, TN Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 Xxxxxxx Xxxxxx Xxxx, #00 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4777
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
Nashville, TN Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
000 Xxxxxxxxx Xxxx Xx, #0 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxxxxx, XX 00000 Medicare - Part B [*] 60694-4770
(000) 000-0000 National Association Boards of Pharmacy [*]
(000) 000-0000 fax Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
Austin, TX Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 X. Xxxxxx Xxxx, #000 Xxxxxxx Xxx XX Number [*] Chicago, IL
Xxxxxx, XX 00000 Home Health Agency License [*] 60694-4805
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
Dallas, TX CHC of North Texas DEA Registration [*] X.X. Xxx 00000
0000 Xxxxx Xxxx Xxxxxx, #0000 Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxx, XX 00000 Home Health Agency License [*] 60694-4762
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident Controlled Substance [*]
Non-Resident Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
El Paso, TX Coram Alternate Site Services Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
0000 Xxxxxx Xxxxxx, Xxx X DEA Registration [*] Xxxxxxx, XX
Xx Xxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
Houston, TX Coram Alternate Site Services DEA Registration [*] P.O. Box 74770
3610 Willowbend, #1010 Federal Tax ID Number [*] Chicago, IL
Xxxxxxx, XX 00000 Home Health Agency License [*] 60694-4770
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
ATTACHMENT B
------------------------------------------------------------------------------------------------------------------------------------
San Antonio, TX Coram Alternate Site Services Federal Tax ID Number [*] X.X. Xxx 00000
9652 Data Point, #102 Home Health Agency License [*] Chicago, IL
Xxx Xxxxxxx, XX 00000 60694-4805
------------------------------------------------------------------------------------------------------------------------------------
Salt Lake City, UT CHC of Utah DEA Registration [*] X.X. Xxx 00000
1149 West 2240 South, Ste A Federal Tax ID Number [*] Xxxxxxx, XX
Xxxx Xxxx Xxxx, XX 00000 Home Health Agency License [*] 60694-4845
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Controlled Substance [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Chantilly, VA CHC of Greater D.C. Clinical Lab Improvement Waiver Cert. [*] X.X. Xxx 00000
0000 Xxxxxxxx Xxxxxxx, #000 DEA Registration [*] Xxxxxxx, XX
Xxxxxxxxx, XX 00000 Federal Tax ID Number [*] 00000-0000
(000) 000-0000 Home Health Agency License [*]
(000) 000-0000 fax JCAHO Accreditation [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Virginia Beach, VA Coram Alternate Site Services DEA Registration [*] P.O. Box 74796
5301 Xxxxx Xxxx Road, #114 Federal Tax ID Number [*] Chicago, IL
Xxxxxxx, XX 00000 Home Health Agency License [*] 60694-4796
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT B
------------------------------------------------------------------------------------------------------------------------------------
Bellevue, WA Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
0000 000xx Xxxxxx, XX, Xxxxx 000 Xxxxxxx Xxx XX Number [*] Chicago, IL
Xxxxxxxx, XX 00000 Home Health Agency License [*] 60694-4805
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Dunbar, WV Coram Alternate Site Services DEA Registration [*] X.X. Xxx 00000
000 Xxxxxxxx Xxxxxxxx Xxxx Xxxxxxx Tax ID Number [*] Chicago, IL
Xxxxxx, XX 00000 JCAHO Accreditation [*] 60694-4792
(000) 000-0000 Medicare - Part B [*]
(000) 000-0000 fax National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Controlled Substance [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
Marshfield, WI Wisconsin IV Affiliates Federal Tax ID Number [*] X.X. Xxx 00000
Partnership 000 Xx. Xxxxxx Xxxxxx, X Wing Home Health Agency License [*] Chicago, IL
Xxxxxxxxxx, XX 00000 Medicare - Part B [*] 60694-4894
(000) 000-0000
------------------------------------------------------------------------------------------------------------------------------------
Milwaukee, WI Coram Alternate Site Services Clinical Lab Improvement Waiver Cert [*] X.X. Xxx 00000
00000 DEA Registration [*] Chicago, IL
W. Victor Road Federal Tax ID Number [*] 00000-0000
Xxx Xxxxxx, XX 00000 Home Health Agency [*]
(000) 000-0000 JCAHO Accreditation [*]
(000) 000-0000 fax Medicare - Part A [*]
Medicare - Part B [*]
National Association Boards of Pharmacy [*]
Non-Resident State Pharmacy Permit [*]
Non-Resident State Pharmacy Permit [*]
Resident State Pharmacy Permit [*]
------------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT C
BECTON XXXXXXXXX INFUSION THERAPY SYSTEMS
-------------------------------------------------------------------------------
ANNUAL MINIMUM COMMITTED VOLUME
-------------------------------------------------------------------------------
PRODUCT YEAR YEAR YEAR YEAR 5 YEAR 6
CATEGORY 99/2000 2000/2001 2001/2002 2002/2003 2003/2004
-------------------------------------------------------------------------------
SAFETY [*]
CATHETERS
-------------------------------------------------------------------------------
PERIPHERAL [*]
CATHETERS
o Insyte
o E-Z Sets
o Saf-T-Intima
o Insyte Autoguard
-------------------------------------------------------------------------------
EXTENDED [*]
DWELL
CATHETERS
o First PICC
o First Mid-Cath
o Introsyte
-------------------------------------------------------------------------------
ATTACHMENT D
BECTON XXXXXXXXX INJECTION SYSTEMS
-------------------------------------------------------------------------------
ANNUAL MINIMUM COMMITTED VOLUME
-------------------------------------------------------------------------------
PRODUCT YEAR YEAR YEAR YEAR 5 YEAR 6
CATEGORY 99/2000 2000/2001 2001/2002 2002/2003 2003/2004
-------------------------------------------------------------------------------
SAFETY [*]
SYRINGES
-------------------------------------------------------------------------------
HYPODERMICS [*]
o Needles
o Syringes
o Safety Products
o Pharmacy Products
-------------------------------------------------------------------------------
INTERLINK(TM) [*]
NEEDLELESS
SYSTEM
-------------------------------------------------------------------------------
SHARPS [*]
COLLECTORS
-------------------------------------------------------------------------------
2
ATTACHMENT E
BECTON XXXXXXXXX CONSUMER PRODUCTS
-------------------------------------------------------------------------------
ANNUAL MINIMUM COMMITTED VOLUME
-------------------------------------------------------------------------------
PRODUCT YEAR YEAR YEAR YEAR YEAR
CATEGORY 99/2000 2000/2001 2001/2002 2002/2003 2003/2004
-------------------------------------------------------------------------------
B-D [*]
MICROFINE
SYRINGES
-------------------------------------------------------------------------------
B-D [*]
ULTRAFINE
SYRINGES
-------------------------------------------------------------------------------
B-D [*]
UNTRAFINE II
SHORT
SYRINGES
-------------------------------------------------------------------------------
B-D [*]
ULTRAFINE
LANCETS
-------------------------------------------------------------------------------
3
ATTACHMENT F
BECTON XXXXXXXXX VACUTAINER SYSTEMS
-------------------------------------------------------------------------------
ANNUAL MINIMUM COMMITTED VOLUME
-------------------------------------------------------------------------------
PRODUCT YEAR YEAR YEAR YEAR 5 YEAR 6
CATEGORY 99/2000 2000/2001 2001/2002 2002/2003 2003/2004
-------------------------------------------------------------------------------
SAFE BLOOD [*]
COLLECTION
-------------------------------------------------------------------------------
4
ATTACHMENT G
VALUE SUMMARY
(updated 6/99)
PROGRAM DESCRIPTION ESTIMATED VALUE TO CORAM
------------------- ------------------------
o Conversion Completion Allowance [*]
o Clinical education support services -
o An educational allowance for purchase of materials from
BD's extensive education catalog. (Delivered)
o BD will provide each of your branch locations with a copy of
our IV Therapy competency program for your use to satisfy the [*]
annual JCAHO competency requirement. (maximum = 125)
(Delivered)
---------------------------------------------------------------------------------------------------
o PICC line certification allowance redeemable as either BD
provided or Coram conducted programs. [*]
---------------------------------------------------------------------------------------------------
o Educational allowance for use at your National Sales meeting [*]
with BD's representation at the meeting upon request. [*] over [*] years
---------------------------------------------------------------------------------------------------
o One CE pharmacy diabetes program every year [*]/pharmacist
[*] over [*] years
[*] accreditation fee/RPh
---------------------------------------------------------------------------------------------------
o Ten diabetes in - services/year for home health care RNs [*] per in-service
[*] per year
[*] over [*] years
---------------------------------------------------------------------------------------------------
o One customized mail-order piece/year for diabetes members - [*]/piece
BD provides material and customization - in discussion now. [*] per year
[*] over [*] years
---------------------------------------------------------------------------------------------------
Additional Investments from BD After Original Contract Execution
---------------------------------------------------------------------------------------------------
PROGRAM DESCRIPTION ESTIMATED VALUE TO CORAM
------------------- ------------------------
Train the Trainer program conducted in support of developing a Cost of consultant - [*]
clinical management team. Twenty (20) clinicians not only Cost of program - [*]
received training in BD products but a consultant of Coram's
choice did a 1/2 day session on adult learning. All flown to central
location at BD's expense. [*]
---------------------------------------------------------------------------------------------------
A reward system to send top two Coram trainers to either XXXXXX [*]
or INS - clinician's choice
---------------------------------------------------------------------------------------------------
Conversion to BD - from HDC. Conversion allowance of [*] [*]
credit toward purchase of future BD product provided when
branches were unable to exhaust HDC inventory after six months.
---------------------------------------------------------------------------------------------------
5
