HomeMy WebLinkAbout20001176.tiff NORTH COLORADO
MEDICAL CENTER FOUNDATION
1801 16th Street
Greeley,Colorado 80631-5199
303 356-9020
Mark Wallace, MD
Weld County Health Department Clinics
1551 North 17th Avenue
Greeley, CO 80631
Dear Dr. Wallace:
Enclosed is the signed contract for the Med-Aid Prescription Assistance Program. If it is approved and
signed,I would appreciate if you could return a copy to me at:
NCMC Foundation
1801 16th Street
Greeley, CO 80631
Thank you.Please phone me at(970)392-2441 if you have any questions.
Sincerely,
Shannon Quinn
Program Coordinator
6) '7--
-A-rao00 2000-1176
NORTH COLORADO MEDICAL CENTER FOUNDATION
SPECIAL PROJECTS CONTRACT
Contract between North Colorado Medical Center Foundation, 1801 16th Street, Greeley,
Colorado, and Weld County Health Department Clinics, 1551 North 17th Avenue, Greeley,
Colorado.
North Colorado Medical Center Foundation agrees to reimburse K Mart Pharmacy#4934, 2400
West 29th Street, Greeley, Colorado, OR King Soopers Pharmacy at Sunrise 1028 5th Avenue.
Greeley, Colorado, for medications provided to those who are determined by a financial
screening at Weld County Health Department Clinics to be unable to pay for prescription
medications. This program will commence on March 1, 2000 and will continue until February
28, 2001; OR until funds have been dispersed; OR until either of the parties notifies the other in
writing that this contract is canceled.
This contract shall be in effect from March 1, 2000 to February 28, 2001.
This program, known as the Med-Aid Prescription Assistance Program, is co-funded by the
United Way of Weld County. The purpose of this program is to enable Weld County residents,
who are determined to be unable to afford prescription medications, to obtain one-time
prescription assistance for acute medical conditions.
Weld County Health Department Clinics agree to the following:
1. Abide by the terms of this "Special Projects Contract" and with the Med-Aid guidelines
(in program notebook).
2. Screen for financial need. Patient should have no access to any other funding source for
prescription medications. Med-Aid is the funding of last resort.
3. Refer only Weld County residents to the Med-Aid Prescription Assistance Program.
4. Prescribe only the medications listed on the Med-Aid formulary (in program notebook).
5. Limit individuals to one-time assistance for one prescription medication.
6. Work with pharmacists to identify and recommend revisions to the formulary.
North Colorado Medical Center Foundation agrees to:
1. Administer the Med-Aid program and work with the Med-Aid Advisory Committee to set
policy and formulate program changes.
2. Consider revisions to the formulary as recommended by Weld County Health Department
Clinics, other participating providers and participating pharmacists.
3. Ensure the program meets the acute prescriptions needs of indigent Weld County
residents.
NORTH COLORADO MEDICAL CENTER FOUNDATION
SPECIAL PROJECTS CONTRACT
Page 2
This Special Projects Contract is approved:
2000
Dated effective
day of
and is for the period � "`_ k 1 ��
to February 28, 2001. �� man, and of Ccunty Oommi srr Hers
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k1/4 fir ,p ' ,D COUNTY CLERK IQ 'THE"gARD
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NORTH CO ORADO MEDICAL CENTER FOUNDATION
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