Acct # 2952
BOEHRINGER MANNHEIM CORPORATION
MEDICARE STRIP REBATE CREDIT PROGRAM
Xxxxxxxx # X000
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MEDICARE/MEDICAID STRIP REBATE CREDIT
PURCHASING AGREEMENT
This Agreement is made this 22 day of May, 1997, by and between Boehringer
Mannheim Corporation ("BMC") and Certified Diabetic Supplies Inc.
("Distributor").
The parties hereto agree as follows:
1. Products and Price
A. BMC will sell to Distributor the products set forth on Exhibit A, attached
hereto and incorporated by reference, at the prices set forth on such exhibit.
Distributor agrees to purchase such products direct from BMC in case quantities
through the use of a separate purchase order than for other BMC products. BMC
agrees to ship products within five days of BMC's receipt of Distributor's
purchase order. Distributor agrees to resell such products only to Medicare or
Medicaid Customers (defined below). In addition, Distributor agrees to abide by
BMC's established direct account return goods policy.
B. The prices of Exhibit A products may be adjusted with thirty days' notice by
BMC if BMC adjusts its distributor pricing.
C. BMC reserves the right to add products to or delete products from Exhibit A
upon ninety (90) days notice to Distributor.
D. Distributor agrees to the volume and share commitments set forth on Exhibit
D. If Distributor does not meet the commitments, BMC may terminate this
Agreement by written notice to Distributor.
2. Rebates
A. Distributor represents and warrants to BMC that it is a party to a Medicare
and/or state(s) Medicaid participation agreement.
B. BMC will issue a credit to the Distributor for rebate amounts set forth on
Exhibit B for sales made to customers for which Distributor accepts assignment
of Medicare and/or Medicaid claims (hereinafter referred to as Customers).
The rebates on Exhibit B for Advantage and Instant strips are available
only if the total BMC strip share is equal to or greater than * of all blood
glucose monitoring strips sold to Medicare/Medicaid patients during the previous
calendar *. BMC strip share is defined as the * of all BMC strips sold to
Medicare/Medicaid patients during the previous * divided by the * of all strips
sold to Medicare/Medicaid patients during the previous *.
C. BMC will issue a credit to the Distributor for Medicaid Customers if the
state's Medicaid Programs (see Exhibit E for approved states) reimbursement for
strips is equal to or less than the Medicare strip reimbursement national
ceiling (e.g. Medicare's national ceiling for a vial of 50 strips in 1997 is
* ).
D. Distributor may claim rebates no more often than *. Distributor shall
provide BMC with a summary of sales made to Medicare and/or Medicaid Customers,
broken down by product by the 10th day of the month. The information provided to
BMC shall be in the form set forth on Exhibit C. The minimum rebate amount that
may be claimed is *. If Distributor's sales are insufficient to allow
Distributor to claim the minimum amount in any *, Distributor may claim a
rebate in a subsequent
-----------------------
* Confidential treatment requested. Portions of this document have been
omitted by blocking out the relevant text pursuant to an Application for
Confidential Treatment. Such blocked out omissions have been filed
separately with the Securities and Exchange Commission. The Registrant
shall furnish all omitted schedules and exhibits to this document upon
the request of the Securities and Exchange Commission.
PAGE 1
BOEHRINGER MANNHEIM CORPORATION
MEDICARE STRIP REBATE CREDIT PROGRAM
* by aggregating sales from *. Rebates for Advantage and Instant strips based on
attainment of at least * share as indicated in 2.B. may only be requested *.
E. BMC agrees to issue a credit to the Distributor for any rebate due within 10
days of receipt of rebate claim and information as specified in C.
F. Distributor has provided BMC with its Medicare and/or Medicaid supplier
number and hereby authorizes BMC to request information from Medicare and/or
Medicaid relating to sales of BMC products to Customers. Distributor will either
provide customer information (product, date sold and customer Medicare and/or
Medicaid number) with its rebate request form or allow a monthly on-site audit
by a BMC representative. Distributor also agrees that BMC may audit , at any
time upon reasonable notice, Distributor's records to determine that rebates
have been paid correctly. Distributor shall promptly reimburse BMC for any
amounts that the audit determines have been paid incorrectly.
3. Term/Termination
A. The term of this Agreement shall be for a period of one year from the date
hereof. Upon agreement by BMC and Distributor to revisions in the volume and
share commitments set forth in Exhibit D, this Agreement shall automatically
renew for additional one-year periods unless either party gives the other party
sixty (60) days notice that it does not desire to renew the Agreement.
B. Either party may terminate this Agreement upon sixty (60) days written notice
to the other in the event that (i) the other party becomes unable to pay its
debts as they occur in the ordinary course of business or commits any act of
bankruptcy; or (ii) the other party breaches this Agreement and fails to cure
said breach within thirty (30) days from its receipt of written notice from the
other party specifying such breach.
C. BMC may terminate this Agreement immediately upon written notice from BMC to
Distributor in the event that BMC has reason to believe that Distributor is
offering for sale any of the products purchased under this Agreement to
customers who are not Medicare and/or Medicaid Customers or that Distributor is
claiming rebates for sales that were not made to Medicare and/or Medicaid
Customers. In the event Distributor offers for sale any of the products
purchased under this Agreement to customers who are not Medicare and/or Medicaid
Customers or claims rebates for sales that were not made to Medicare and/or
Medicaid Customers, Distributor agrees to pay to BMC an amount equal to the
total rebate received for such products, plus a twenty-five percent (25%)
handling fee to compensate BMC for the costs of processing such rebates.
4. General
A. Assignment: This Agreement shall not be assigned by either party without the
prior and express written consent of the other.
B. Entire Agreement: This Agreement constitutes the entire agreement between the
parties, and no other agreements, whether written or oral, shall be used to
construe, alter, or modify the terms of this Agreement. This Agreement may be
amended only by a written document signed by both of the parties hereto.
C. Independent Contractors: The relationship between the parties to this
Agreement shall be that of independent contractors and neither party shall be
considered the agent of the other party or to have an authority to act for or on
behalf of the other party.
D. Governing Law: This Agreement shall be governed by and construed in
accordance with the laws of the State of Indiana.
---------------------
* Confidential treatment requested. Portions of this document have been
omitted by blocking out the relevant text pursuant to an Application for
Confidential Treatment. Such blocked out omissions have been filed
separately with the Securities and Exchange Commission. The Registrant
shall furnish all omitted schedules and exhibits to this document upon
the request of the Securities and Exchange Commission.
PAGE 2
BOEHRINGER MANNHEIM CORPORATION
MEDICARE AND/STRIP REBATE CREDIT PROGRAM
-------------------------------------------------------------------------------
Distributor: BMC
Name CERTIFIED DIABETIC SUPPLIES INC. BOEHRINGER MANNHEIM CORPORATION
---------------------------------
Acct No. 2452-0 By: /s/ XXXX X. XXXXXX
----------------------- ------------------------------
Address 1951 JC Boulevard Title: CONTRACTS
----------------------- ---------------------------
(To be signed by BMC Contract
Administrator only)
City/State/Zip XXXXXX, XXXXXXX 00000
----------------------
By: /S/ ILLEGIBLE Account Manager: /S/ XXXXXX XXXXXX
------------------------ --------------------
Title: PRES/CEO Acct Mgr Territory 4164
--------------------- --------------
Medicare Supplier Number: Acct Mgr ASPEN 5123
--------------
0925330001
------------------------
Medicaid Supplier Number:
N/A
------------------------
States with sales to Medicaid beneficiary:
---------------------------------
---------------------------------
---------------------------------
---------------------------------
Standing X.X. #
000000
---------------------------------
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Mail contract and first order (allow 30 days for delivery)
Boehringer Mannheim Corporation
Diabetes Care Contract Administration
0000 Xxxxx Xxxx
Xxxxxxxxxxxx, Xxxxxxx 00000
PAGE 3
BOEHRINGER MANNHEIM CORPORATION
MEDICARE/MEDICAID STRIP REBATE CREDIT PROGRAM
EXHIBT A
(LIST OF PRODUCT)
------------------------------------------------------------------------------------------------------------
PRODUCT NDC. NO CATALOG NUMBER QUANTITY UNIT COST
------------------------------------------------------------------------------------------------------------
Chemstrip(R)bG 00000-000-00 00502 50/vial **
------------------------------------------------------------------------------------------------------------
Tracer(R)Strips 00000-000-00 00535 50/vial **
------------------------------------------------------------------------------------------------------------
Accu-Chek(R) 00000-000-00 336 50/vial **
Advantage(TM) Strips
------------------------------------------------------------------------------------------------------------
Accu-Chek(R)Easy(TM) 00000-000-00 00560 50/vial **
Test Strips *
------------------------------------------------------------------------------------------------------------
Accu-Chek(R)Instant(TM) 00000-000-00 337 50/vial **
Strips *
------------------------------------------------------------------------------------------------------------
* Note: The discounted price of these two products is reflected in the purchase
price and honored if BMC strip volume is equal to or greater than **.
Account Signature /S/ ILLEGIBLE Date 6/24/97
------------------------- --------------------
-------------------
** Confidential treatment requested. Portions of this document have been
omitted by blocking out the relevant text pursuant to an Application for
Confidential Treatment. Such blocked out omissions have been filed
separately with the Securities and Exchange Commission. The Registrant
shall furnish all omitted schedules and exhibits to this document upon
the request of the Securities and Exchange Commission.
BOEHRINGER MANNHEIM CORPORATION
MEDICARE/MEDICAID STRIP REBATE CREDIT PROGRAM
EXHIBIT B
(REBATE AMOUNTS PER PRODUCTS)
--------------------------------------------------------------------------------------------
PRODUCT CATALOG NUMBER REBATE
(BMC share of business must be maintained)
--------------------------------------------------------------------------------------------
Chemstrip(R)bG 00502 *
--------------------------------------------------------------------------------------------
Tracer(R)Strips 00535 *
--------------------------------------------------------------------------------------------
Accu-Chek(R)Easy(TM) 00560 *
Test Strips *
--------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------
PRODUCT CATALOG NUMBER REBATE
(BMC previous quarterly share of business
must be equal to or greater than *)
--------------------------------------------------------------------------------------------
Accu-Chek(R) 336 *
Advantage(TM) Strips
--------------------------------------------------------------------------------------------
Accu-Chek(R) 337 *
Instant(TM) Strips
--------------------------------------------------------------------------------------------
Account Signature /S/ ILLEGIBLE Date 6/24/97
---------------------------- ---------------------
-------------------
* Confidential treatment requested. Portions of this document have been
omitted by blocking out the relevant text pursuant to an Application for
Confidential Treatment. Such blocked out omissions have been filed
separately with the Securities and Exchange Commission. The Registrant
shall furnish all omitted schedules and exhibits to this document upon
the request of the Securities and Exchange Commission.
CONTRACT M103 BOEHRINGER [LOGO]
MANNHEIM
CORPORATION
Exhibit C
MEDICARE STRIP REBATE REQUEST FORM
NAME Certified Diabetic Supplies Inc. CUST DEBIT MEMO__________________________________ REQUEST DATE____________________________
ACCT #/SHIP TO__________________________________ CONTRACT #______________________________
MEDICARE SUPPLIER #_____________________________
-------------------------------------------------------------------------------------------------------------------------------
BEGINNING ENDING CATALOG BILLED CONTRACTED REBATE AMOUNT NUMBER OF TOTAL
DATE DATE NUMBER PRICE PRICE VIALS SOLD REBATE
SOLD SOLD PER VIAL PER VIAL
-------------------------------------------------------------------------------------------------------------------------------
502 * * *
-------------------------------------------------------------------------------------------------------------------------------
535 * * *
-------------------------------------------------------------------------------------------------------------------------------
560 * * *
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TOTALS
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--------------------------------
Mail to:
Boehringer Mannheim Corporation
Attention: Rebate Administration
Medicare - H
0000 Xxxxx Xxxx
Xxxxxxxxxxxx, XX 00000
---------------------------------
NOTE: THE FOLLOWING CUSTOMER INFORMATION MUST BE ATTACHED:
PRODUCT, DATE SOLD, AND CUSTOMER MEDICARE NUMBER
[ ] (Check here) Data will be provided during BMC monthly on-site audit.
PRODUCT CLASS 850701 SUPPLIER AUTHORIZED SIGNATURE /S/ ILLEGIBLE
-------------------
RR#________________________________________________
BMC USE ONLY
The name of the Medicare Customer and the Customer's Medicare number shall be
treated as confidential information by BMC and shall not be disclosed to third
parties or used except in connection with the administration of the Medicare
Strip Rebate Purchasing Agreement, or as may be required by law.
-------------------
* Confidential treatment requested. Portions of this document have been
omitted by blocking out the relevant text pursuant to an Application for
Confidential Treatment. Such blocked out omissions have been filed
separately with the Securities and Exchange Commission. The Registrant
shall furnish all omitted schedules and exhibits to this document upon the
request of the Securities and Exchange Commission.
BOEHRINGER MANNHEIM CORPORATION
MEDICARE/MEDICAID STRIP REBATE CREDIT PROGRAM
EXHIBIT D
(ANNUAL VOLUME AND SHARE COMMITMENTS)
ANNUAL STRIP SALES VOLUME COMMITMENT
-----------
PRIOR 12 MONTH BMD STRIP SALES GOAL **
-----------
-----------
NEXT 12 MONTH BMD STRIP SALES GOAL **
From June 1, 1997 TO May 31, 1998
-----------
o 1st quarter interim goal **
-----------
o 2nd quarter interim goal **
-----------
o 3rd quarter interim goal **
-----------
ANNUAL SHARE OF BUSINESS COMMITMENT
-------------------------------------------------------------------------------------- -----------------------------
COMPANY PRIOR 12 MONTH ACTUAL SHARE OF BUSINESS COMMITMENT
-------------------------------------------------------------------------------------- -----------------------------
$ % %
-------------------------------------------------------------------------------------- -----------------------------
BMD* ** ** **
-------------------------------------------------------------------------------------- -----------------------------
Lifescan -- **
--------------------------------------------------------------------------------------
Miles
--------------------------------------------------------------------------------------
Medisense
--------------------------------------------------------------------------------------
Polymer
--------------------------------------------------------------------------------------
Can Am
--------------------------------------------------------------------------------------
Other:
-- **
--------------------------------------------------------------------------------------
TOTAL * Bayer -- **
--------------------------------------------------------------------------------------
* Required fields
BMC Account Manager Signature_________________________ Date___________________
Account Signature /S/ ILLEGIBLE Date 6/24/97
------------------------------------ -------------------
-----------------
** Confidential treatment requested. Portions of this document have been
omitted by blocking out the relevant text pursuant to an Application for
Confidential Treatment. Such blocked out omissions have been filed
separately with the Securities and Exchange Commission. The Registrant
shall furnish all omitted schedules and exhibits to this document upon the
request of the Securities and Exchange Commission.
BOEHRINGER MANNHEIM CORPORATION
MEDICARE/MEDICAID STRIP REBATE CREDIT PROGRAM
EXHIBIT E
State Medicaid Programs with strip reimbursement below the Medicare national
ceiling (e.g. vial of 50 strips *)
---------------------------------------------------------
State Effective
---------------------------------------------------------
Arizona 1/1/97
---------------------------------------------------------
Colorado 1/1/97
---------------------------------------------------------
Delaware 1/1/97
---------------------------------------------------------
Georgia 1/1/97
---------------------------------------------------------
Idaho 1/1/97
---------------------------------------------------------
Indiana 1/1/97
---------------------------------------------------------
Kansas 1/1/97
---------------------------------------------------------
Kentucky 1/1/97
---------------------------------------------------------
Minnesota 1/1/97
---------------------------------------------------------
Missouri 1/1/97
---------------------------------------------------------
Montana 1/1/97
---------------------------------------------------------
Nebraska 1/1/97
---------------------------------------------------------
Nevada 1/1/97
---------------------------------------------------------
New Mexico 1/1/97
---------------------------------------------------------
North Carolina 1/1/97
---------------------------------------------------------
North Dakota 1/1/97
---------------------------------------------------------
Ohio 1/1/97
---------------------------------------------------------
Oklahoma 1/1/97
---------------------------------------------------------
Rhode Island 1/1/97
---------------------------------------------------------
South Dakota 1/1/97
---------------------------------------------------------
Texas 1/1/97
---------------------------------------------------------
Washington 1/1/97
---------------------------------------------------------
Wisconsin 1/1/97
---------------------------------------------------------
Wyoming 1/1/97
---------------------------------------------------------
----------------
* Confidential treatment requested. Portions of this document have been
omitted by blocking out the relevant text pursuant to an Application for
Confidential Treatment. Such blocked out omissions have been filed
separately with the Securities and Exchange Commission. The Registrant
shall furnish all omitted schedules and exhibits to this document upon the
request of the Securities and Exchange Commission.
