EX-10.3 Becton Dickinson Supply Agreement
EX-10.3 5 d09791exv10w3.txt EX-10.3 BECTON DICKINSON SUPPLY AGREEMENT 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 Dickinson and Company, having a principal place of business at 1 Becton Drive, Franklin Lakes, NJ 07417 ("Supplier") and Coram Healthcare, having offices at Suite 2100, 1125 17th Street, Denver, Colorado 80202 ("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 Dickinson and Company Products but presently limited to products sold by Becton Dickinson Medical, Becton Dickinson Consumer Products, Becton Dickinson Infusion Therapy Systems, and Becton Dickinson VACUTAINER Systems. See product lines covered on Attachment A ("Products"). Becton Dickinson 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 Dickinson 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 Dickinson Divisions or Becton Dickinson 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 Dickinson 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 Dickinson Infusion Therapy Systems items defined in Attachment C 2. Becton Dickinson Injection Systems items defined in Attachment D 3. Becton Dickinson Consumer Products items defined in Attachment F 4. Becton Dickinson Vacutainer Systems items defined in Attachment F 5. Becton Dickinson Divisions Value Offerings items defined in Attachment G 6. Becton Dickinson 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 Dickinson 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 Dickinson 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 Dickinson 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 Dickinson 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 Robinson-Patman Act. Coram 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 DICKINSON AND COMPANY By: /s/ ROBERT ROOSE, JR. By: /s/ HOWARD SANDERS -------------------------------------- ------------------------------ 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" TW IV 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 Cannula 303402 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 ###-###-#### 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 ###-###-#### 22ga x 3/4" Y-Set ###-###-#### Sat-T Intima 24ga x 3/4" PRN ###-###-####
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 [*] P.O. Box 71231 400 River Hills Business Park, $ 435 Federal Tax ID Number [*] Chicago, IL Birmingham, AL 35242 JCAHO Accreditation [*] 60694-1231 ###-###-#### National Association Boards of Pharmacy [*] (205) 995-8165 fax Resident State Controlled Substance [*] Resident State Pharmacy Permit [*] - ------------------------------------------------------------------------------------------------------------------------------------ Montgomery, AL CHC of Alabama Clinical Lab Improvement Waiver Cert. [*] P.O. Box ###-###-#### West Second Street, Ste A Federal Tax ID Number [*] Chicago, IL Montgomery, AL 36106 JCAHO Accreditation [*] 60694-1231 ###-###-#### ###-###-#### fax - ------------------------------------------------------------------------------------------------------------------------------------ Phoenix, AZ Coram Alternate Site Services Clinical Lab Improvement Waiver Cert. [*] P.O. Box ###-###-#### West First Street DEA Registration [*] Chicago, IL Tempe, AZ 85281 Federal Tax ID Number [*] 60694-1805 ###-###-#### JCAHO Accreditation [*] (602) 967-1367 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 [*] P.O. Box ###-###-#### S. Palo Verde, #205 Federal Tax ID Number [*] Chicago, IL Tucson, AZ 85714 Home Health Agency License [*] 60694-1805 ###-###-#### JCAHO Accreditation [*] (520) 790-8985 fax Medicare - Part A [*] Medicare - Part B [*] National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] - ------------------------------------------------------------------------------------------------------------------------------------ Bakersfield, CA Kern Home Health DEA Registration [*] P.O. Box 74881 Partnership d/b/a Coram Healthcare Federal Tax ID Number [*] Chicago, IL 3101 Sillect Avenue, #109 Home Health Agency License [*] 60694-1881 Bakersfield, CA 93308 JCAHO Accreditation [*] (805) 325-8326 Medicare - Part B [*] (805) 325-6509 fax National Association Boards of Pharmacy [*] Resident State Controlled Substance [*] - ------------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT B Glendale, CA CHC of Southern California Clinical Lab Improvement Waiver Cert. [*] P.O. Box ###-###-#### Grand Central Avenue DEA Registration [*] Chicago, IL Glendale, CA 91201 Federal Tax ID Number [*] 60694-4790 ###-###-#### Home Health Agency License [*] (818) 956-0411 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. [*] P.O. Box 74798 21353 Cabot Boulevard DEA Registration [*] Chicago, IL Hayward, CA 94545 Federal Tax ID Number [*] 60694-4798 ###-###-#### Home Health Agency License [*] (510) 732-8801 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. [*] P.O. Box ###-###-#### E. Lowell Street, Ste E DEA Registration [*] Chicago, IL Ontario, CA 91761 Federal Tax ID Number [*] 60694-4798 ###-###-#### Home Health Agency License [*] (909) 605-0024 Medicare - Part B [*] National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] Sacramento, CA Coram Homecare of N. CA Clinical Lab Improvement Waiver Cert. [*] P.O. Box 74798 Nursing Only 1803 Tribute Road, Ste B Federal Tax ID Number [*] Chicago, IL Sacramento, CA 95815 Home Health Agency License [*] 60694-4798 ###-###-#### JCAHO Accreditation [*] (916) 924-0870 fax Medicare - Part A [*] [*] Sacramento, CA CHC of Northern CA DEA Registration [*] P.O. Box 74798 Pharmacy Only 1803 Tribute Road, Ste B Federal Tax ID Number [*] Chicago, IL Sacramento, CA 95815 JCAHO Accreditation [*] 60694-4798 ###-###-#### Medicare - Part B [*] (916) 924-0870 fax National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] [*]
ATTACHMENT B San Diego, CA Coram Alternate Site Service Clinical Lab Improvement Waiver Cert. [*] P.O. Box ###-###-#### Balboa Avenue DEA Registration [*] Chicago, IL San Diego, CA 92123 Federal Tax ID Number [*] 60694-1801 ###-###-#### Home Health Agency License [*] (619) 974-6606 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. [*] P.O. Box 74790 200 East Carrillo, Ste 100-A Federal Tax ID Number [*] Chicago, IL Santa Barbara, CA 93101 Home Health Agency License [*] 60694-4790 ###-###-#### JCAHO Accreditation [*] (805) 568-0477 fax Tustin, CA CHC of Southern California DEA Registration [*] P.O. Box 74790 15031 Parkway Loop, Unit B Federal Tax ID Number [*] Chicago, IL Tustin, CA 92680 National Association Boards of Pharmacy [*] 60694-4790 ###-###-#### Resident State Pharmacy Permit [*] (714) 247-1167 fax Denver, CO Coram Alternate Site Services DEA Registration [*] P.O. Box ###-###-#### S. Revere Parkway, #490 Federal Tax ID Number [*] Chicago, IL Englewood, CO 80112 JCAHO Accreditation [*] 60694-4805 ###-###-#### Medicare-Part B [*] (303) 790-0633 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 [*] P.O. Box 74852 7 Barnes Industrial Park Road Federal Tax ID Number [*] Chicago, IL Wallingford, CT 06492 JCAHO Accreditation [*] 60694-4852 ###-###-#### Medicare - Part B [*] (203) 284-8580 fax National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] Washington, D.C. CHC of Greater D.C. Federal Tax ID Number [*] P.O. Box ###-###-#### M Street NW, Suite 104 Chicago, IL Washington, D.C. 20037 60694-4780 Milford, DE Coram Alternative Site Services Federal Tax ID Number [*] P.O. Box 74775 Rehoboth Blvd, Route 300 J Chicago, IL Milford, DE 19963 60694-4775 ###-###-#### ###-###-#### fax Orlando, FL Coram Alternative Site Services DEA Registration [*] P.O. Box 74803 376 S. Northlake Blvd, #1008 Federal Tax ID Number [*] Chicago, IL Altamonte Springs, FL 32701 Home Health Agency [*] 60694-4803 ###-###-#### Medicare - Part B [*] (407) 339-8840 fax National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] Boca Raton, FL CHC of Southern Florida Clinical Lab Improvement Waiver Cert. [*] P.O. Box 74781 902 Clint Moore Road, #138 DEA Registration [*] Chicago, IL Boca Raton, FL 33487 Federal Tax ID Number [*] 60694-4781 ###-###-#### Home Health Agency [*] (407) 241-8125 fax JCAHO Accreditation [*] Medicare - Part B [*] National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] Jacksonville, FL Coram Alternative Site Services DEA Registration [*] P.O. Box ###-###-#### Phillips Highway, #300 Federal Tax ID Number [*] Chicago, IL Jacksonville, FL 32256 Home Health Agency [*] 60694-4803 ###-###-#### JCAHO Accreditation [*] (904) 363-2159 Medicare - Part B [*] National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*]
ATTACHMENT B Miami, FL CHC of Southern Florida DEA Registration [*] P.O. Box ###-###-#### N.W. 82nd Avenue Federal Tax ID Number [*] Chicago, IL Miami, FL 33126 Home Health Agency [*] 60694-4781 ###-###-#### JCAHO Accreditation [*] (305) 592-7989 fax Medicare - Part B [*] National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] Sarasota, FL CHC of Florida DEA Registration [*] P.O. Box ###-###-#### Beneva Road South Federal Tax ID Number [*] Chicago, IL Sarasota, FL 34238 Home Health Agency [*] 60694-4803 ###-###-#### JCAHO Accreditation [*] (941) 923-0670 fax Medicare - Part B [*] National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] Tampa, FL CHC of Florida Clinical Lab Improvement Waiver Cert. [*] P.O. Box ###-###-#### Benjamin Road, #200 DEA Registration [*] Chicago, IL Tampa, FL 33634 Federal Tax ID Number [*] 60694-4803 ###-###-#### Home Health Agency [*] (813) 886-7025 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 [*] P.O. Box 74777 855 Sunset Drive, Unit 11 Home Health Agency [*] Chicago, IL Athens, GA 30606 JCAHO Accreditation [*] 60694-4777 ###-###-#### ###-###-#### fax Atlanta, GA Coram Alternate Site Services DEA Registration [*] P.O. Box ###-###-#### Newmarket Pkwy, #106 Federal Tax ID Number [*] Chicago, IL Marietta, GA 30067 Home Health Agency [*] 60694-4777 ###-###-#### JCAHO Accreditation [*] (770) 952-6840 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 [*] P.O. Box 74805 94-479 Ukee Street Federal Tax ID Number [*] Chicago, IL Waipahu, HI ###-###-#### JGAHO accreditation [*] 60694-4805 ###-###-#### Medicare - Part B [*] (808) 677-2611 National Association Boards of Pharmacy [*] Resident State Controlled Substance [*] Resident State Pharmacy Permit [*] - ------------------------------------------------------------------------------------------------------------------------------------ Boise, ID Coram Alternate Site Services Clinical Lab Improvement Waiver Cert. [*] P.O. Box ###-###-#### Kendall Street DEA Registration [*] Chicago, IL Boise, ID 83706 Federal Tax ID Number [*] 60694-4805 ###-###-#### Home Health Agency License [*] (208) 323-0381 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. [*] P.O. Box 74838 Pharmacy Only 1471 Business Center Dr, #500 DEA Registration [*] Chicago, IL Mt. Prospect, IL 60056 Federal Tax ID Number [*] 60694-4838 ###-###-#### JCAHO Accreditation [*] (847) 803-8635 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. [*] P.O. Box 74838 Nursing Only 1471 Business Center Dr, #500 Federal Tax ID Number [*] Chicago, IL Mt. Prospect, IL 60056 Home Health Agency License [*] 60694-4838 ###-###-#### JCAHO Accreditation [*] (847) 803-8635 fax Medicare - Part A [*] - ------------------------------------------------------------------------------------------------------------------------------------ Chicago, IL ABC Infusion Therapy Federal Tax ID Number [*] P.O. Box 74897 Partnership 1471 Business Center Dr, #500 Medicare - Part B [*] Chicago, IL Mt. Prospect, IL 60056 60694-4897 ###-###-#### ###-###-#### fax - ------------------------------------------------------------------------------------------------------------------------------------ Chicago, IL Hindsale Infusion Care Federal Tax ID Number [*] P.O. Box 74876 Partnership 1471 Business Center Dr, #500 Medicare - Part B [*] Chicago, IL Mt. Prospect, IL 60056 60694-4876 ###-###-#### ###-###-#### fax - ------------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT B - ------------------------------------------------------------------------------------------------------------------------------------ Fort Wayne, IN Coram Alternate Site Services DEA Registration [*] P.O. Box 74825 431 Fernhill Avenue Federal Tax ID Number [*] Chicago, IL Ft. Wayne, IN 46805 Home Health Agency License [*] 60694-4825 ###-###-#### JCAHO Accreditation [*] (219) 484-4637 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 [*] P.O. Box ###-###-#### Lakeview Pkwy W Dr., #111 Federal Tax ID Number [*] Chicago, IL Indianapolis, IN 46268 Home Health Agency License [*] 60694-4825 ###-###-#### JCAHO Accreditation [*] (317) 299-3539 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 [*] P.O. Box 74825 Partnership 7114 Lakeview Pkwy W Dr., #111 Chicago, IL Indianapolis, IN 46268 60694-4825 ###-###-#### ###-###-#### fax - ------------------------------------------------------------------------------------------------------------------------------------ Merrilville, IN CHC of Indiana Clinical Lab Improvement Waiver Cert. [*] P.O. Box 74838 107 West 79th Avenue DEA Registration [*] Chicago, IL Merrilville, IN 46410 Federal Tax ID Number [*] 60694-4838 ###-###-#### Home Health Agency License [*] (219) 736-0849 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 [*] P.O. Box ###-###-#### W. 35th Street Federal Tax ID Number [*] Chicago, IL Davenport, IA 52806 JCAHO Accreditation [*] 60694-4820 ###-###-#### Medicare - Part B [*] (319) 386-4715 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 [*] P.O. Box 74873 Partnership 1008 W. 35th Street Medicare - Part B [*] Chicago, IL Davenport, IA 52806 60694-4873 ###-###-#### ###-###-#### fax - ---------------------------------------------------------------------------------------------------------------------------------- Quad Cities, IA Trinity Home Infusion Federal Tax ID Number [*] P.O. Box 74892 Partnership 1008 W. 35th Street Medicare - Part B [*] Chicago, IL Davenport, IA 52806 60694-4892 ###-###-#### ###-###-#### fax - ---------------------------------------------------------------------------------------------------------------------------------- Kansas City, KS Coram Alternate Site Services DEA Registration [*] P.O. Box ###-###-#### Flint Federal Tax ID Number [*] Chicago, IL Lenexa, KS 66214 Home Health Agency License [*] 60694-5984 ###-###-#### JCAHO Accreditation [*] (913) 599-1195 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. [*] P.O. Box ###-###-#### E. Osie, #401 DEA Registration [*] Chicago, IL Wichita, KS 67207 Federal Tax ID Number [*] 60694-4788 ###-###-#### Home Health Agency License [*] (316) 683-3469 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 [*] P.O. Box 74816 Partnership 7707 E. Osie, #401 Medicare - Part B [*] Chicago, IL Wichita, KS 67207 60694-4816 ###-###-#### ###-###-#### fax - ------------------------------------------------------------------------------------------------------------------------------------ Covington, KY CHC of Kentucky Clinical Lab Improvement Waiver Cert. [*] 50 E. River Center Blvd, #451 Federal Tax ID Number [*] Covington, KY 41011 Home Health Agency License [*] JCAHO Accreditation [*] - ------------------------------------------------------------------------------------------------------------------------------------ Lafayette, LA Coram Alternate Site Services DEA Registration [*] P.O. Box 71265 118 Toledo Drive Federal Tax ID Number [*] Chicago, IL Lafayette, LA 70506 JCAHO Accreditation [*] 60694-1265 ###-###-#### 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 115 James Drive West Home Health Agency License [*] 60694-1265 St. Rose, LA 70087 JCAHO Accreditation [*] (504) 466-5932 Medicare - Part B [*] (504) 468-8310 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 [*] P.O. Box 74780 600 N. Wolfe St., 3rd Floor, #223 Federal Tax ID Number [*] Chicago, IL Baltimore, MD 21287 Resident State Controlled Substance [*] 60694-4780 ###-###-#### Resident State Pharmacy Permit [*] (410) 720-5518 fax Columbia, MD CHC of Greater D.C. DEA Registration [*] P.O. Box ###-###-#### Columbia Gateway Dr, Ste C Federal Tax ID Number [*] Chicago, IL Columbia MD 21046 JCAHO Accreditation [*] 60694-4780 ###-###-#### Medicare - Part B [*] (410) 720-6220 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 [*] P.O. Box 74822 233 South Street Federal Tax ID Number [*] Chicago, IL Hopkinton, MA 01748 JCAHO Accreditation [*] 60694-4822 ###-###-#### Medicare - Part B [*] (508) 435-1989 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 [*] P.O. Box ###-###-#### 4th Street, #190 Federal Tax ID Number [*] Chicago, IL Grand Rapids, MI 49512 JCAHO Accreditation [*] 60694-4766 ###-###-#### Medicare - Part B [*] (616) 940-0496 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 [*] P.O. Box ###-###-#### Enterprise Drive Federal Tax ID Number [*] Chicago, IL Lansing, MI 48911 JCAHO Accreditation [*] 60694-4766 ###-###-#### Medicare - Part B [*] (517) 394-0109 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. [*] P.O. Box 74766 45801 Mast DEA Registration [*] Chicago, IL Plymouth, MI 48170 Federal Tax ID Number [*] 60694-1766 ###-###-#### Home Health Agency License [*] (313) 454-0614 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. [*] P.O. Box 73163 Nursing Only 1355 Mendota Heights Road, #240 Federal Tax ID Number [*] Chicago, IL Mendota Heights, MN 55120 Home Health Agency License [*] 60694-3163 ###-###-#### Hospice [*] (612) 452-9531 fax JCAHO Accreditation [*] Medicare - Part A [*]
ATTACHMENT B - ------------------------------------------------------------------------------------------------------------------------------------ Minneapolis, MN Coram Alternate Site Services DEA Registration [*] P.O. Box 73163 Pharmacy Only 1355 Mendota Heights Road, #240 Federal Tax ID Number [*] Chicago, IL Mendota Heights, MN 55120 JCAHO Accreditation [*] 60694-3163 ###-###-#### Medicare - Part B [*] (612) 452-9531 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 [*] P.O. Box 71265 #2 Old River Place, Ste M Federal Tax ID Number [*] Chicago, IL Jackson, MS 39202 JCAHO Accreditation [*] 60694-1265 ###-###-#### Medicare - Part B [*] (601) 948-3009 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 [*] P.O. Box ###-###-#### 23rd Avenue, #2 Chicago, IL Meridian, MS 39302 60694-1265 ###-###-#### ###-###-#### fax - ------------------------------------------------------------------------------------------------------------------------------- St. Louis, MO Coram Alternate Site Services DEA Registration [*] P.O. Box ###-###-#### Lackland Hill Parkway Federal Tax ID Number [*] Chicago, IL St. Louis, MO 63146 Home Health Agency License [*] 60694-4847 ###-###-#### JCAHO Accreditation [*] (314) 994-0071 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 [*] P.O. Box ###-###-#### S 156th Circle Federal Tax ID Number [*] Chicago, IL Omaha, NE 68130 Home Health Agency License [*] 60694-4841 ###-###-#### JCAHO Accreditation [*] (402) 330-2697 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 [*] P.O. Box ###-###-#### F Street Federal Tax ID Number [*] Chicago, IL Omaha, NE 68117 Medicare - Part B [*] 60694-1505 ###-###-#### National Association Boards of Pharmacy [*] (402) 731-4293 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 [*] P.O. Box 71360 321 Winnie Lane, #104 Federal Tax ID Number [*] Chicago, IL Carson City, NV 89703 JCAHO Accreditation [*] 60694-1360 ###-###-#### Medicare - Part B [*] (702) 885-0819 fax National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] - ------------------------------------------------------------------------------------------------------------------------------------ Las Vegas, NV CHC of Nevada DEA Registration [*] P.O. Box 74773 101 N. Pecos Blvd. #101-105 Federal Tax ID Number [*] Chicago, IL Las Vegas, NV 89101 JCAHO Accreditation [*] 60694-4773 ###-###-#### Medicare - Part B [*] (702) 453-0204 fax National Association Boards of Pharmacy [*] Nursing Pool [*] Resident State Pharmacy Permit [*] - ------------------------------------------------------------------------------------------------------------------------------------ Reno, NV CHC of Nevada DEA Registration [*] P.O. Box ###-###-#### Bible Way Federal Tax ID Number [*] Chicago, IL Reno, NV 89502 JCAHO Accreditation [*] 60694-1360 ###-###-#### Medicare - Part B [*] (702) 333-8220 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 [*] P.O. Box 74822 9 Cedarwood Drive, #3 Federal Tax ID Number [*] Chicago, IL Bedford, NH 03110 Home Health Agency License [*] 60694-4822 ###-###-#### JCAHO Accreditation [*] (603) 644-3655 fax Medicare - Part B [*] National Association Boards of Pharmacy [*] Non-Resident State Pharmacy Permit [*] Resident State Pharmacy Permit [*] - ------------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT B Mt. Laurel, NJ Coram Alternate Site Services DEA Registration [*] P.O. Box 74775 525 Fellowship Road, #355 Federal Tax ID Number [*] Chicago, IL Mt. Laurel, NJ 08054 Health Care Service Firm [*] 60694-4775 ###-###-#### JCAHO Accreditation [*] (609) 235-6044 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 [*] P.O. Box 74849 11 H Commerce Way Federal Tax ID Number [*] Chicago, IL Totowa, NJ 07512 Health Care Service Firm [*] 60694-4849 ###-###-#### JCAHO Accreditation [*] (201) 812-3948 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 [*] P.O. Box ###-###-#### McLeod N.E., Ste B Federal Tax ID Number [*] Chicago, IL Albuquerque, NM 87109 JCAHO Accreditation [*] 60694-4805 ###-###-#### Medicare - Part B [*] (505) 884-4719 fax National Association Boards of Pharmacy [*] Resident State Controlled Substance [*] Resident State Pharmacy Permit [*] Buffalo, NY CHC of New York DEA Registration [*] P.O. Box 74807 375 N. French Road Federal Tax ID Number [*] Chicago, IL Amherst, NY 14228 Home Health Agency License [*] 60694-4807 ###-###-#### JCAHO Accreditation [*] (716) 691-5448 fax Medicare - Part B [*] National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] Syracuse, NY CHC of Greater New York DEA Registration [*] P.O. Box 74807 23 Corporate Circle Drive Federal Tax ID Number [*] Chicago, IL East Syracuse, NY 13057 Home Health Agency License [*] 60694-4807 ###-###-#### JCAHO Accreditation [*] (315) 463-1006 fax Medicare - Part B [*] National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*]
ATTACHMENT B Albany, NY CHC of New York DEA Registration [*] P.O. Box 74807 1 Charles Boulevard Federal Tax ID Number [*] Chicago, IL Guilderland, NY 12084 Home Health Agency License [*] 60694-4807 ###-###-#### Medicare - Part B [*] (518) 869-3760 fax National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] New York, NY CHC of Greater NY Federal Tax ID Number [*] P.O. Box 74849 Nursing Only 17 East 96th Street Home Health Agency License [*] Chicago, IL New York, NY 11803 JCAHO Accreditation [*] 60694-4849 ###-###-#### Long Island, NY CHC of Greater NY DEA Registration [*] P.O. Box 74849 45 S. Service Road Federal Tax ID Number [*] Chicago, IL Plainview, NY 11803 Home Health Agency License [*] 60694-4849 ###-###-#### JCAHO Accreditation [*] (516) 753-5486 fax Medicare - Part B [*] National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] Asheville, NC Coram Alternative Site Services Clinical Lab Improvement Waiver Cert [*] P.O. Box 74784 2 Henderson Road, Ste B-2 DEA Registration [*] Chicago, IL Asheville, NC 28803 Federal Tax ID Number [*] 60694-4784 ###-###-#### Home Health Agency License [*] (704) 251-2697 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. [*] P.O. Box ###-###-####-J Southern Pine Blvd DEA Registration [*] Chicago, IL Charlotte, NC 28273 Federal Tax ID Number [*] 60694-4756 ###-###-#### Home Health Agency License [*] (704) 523-8001 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 [*] P.O. Box ###-###-#### Perimeter Park Drive,#114 Federal Tax ID Number [*] Chicago, IL Morrisville,NC 27560 Home Health Agency License [*] 60694-4784 ###-###-#### JCAHO Accreditation [*] (919) 481-2678 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 [*] P.O. Box ###-###-#### Westpoint Blvd, Ste B Federal Tax ID Number [*] Chicago, IL Winston-Salem, NC 27103 Home Health Agency License [*] 60694-4803 ###-###-#### JCAHO Accreditation [*] (910) 765-5259 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 [*] P.O. Box 74816 53 Circle Freeway Drive Federal Tax ID Number [*] Chicago, IL Cincinnati, OH 45246 JCAHO Accreditation [*] 60694-4816 ###-###-#### Medicare - Part B [*] (513) 874-8774 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 [*] P.O. Box ###-###-#### Emery Industrial Pkwy, Ste P Federal Tax ID Number [*] Chicago, IL Warrensville Heights, OH 44128 JCAHO Accreditation [*] 60694-4816 ###-###-#### Medicare - Part B [*] (216) 591-0664 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 [*] P.O. Box ###-###-#### Emery Industrial Pkwy, Ste P Federal Tax ID Number [*] Chicago, IL Warrensville Heights, OH 44128 Resident State Pharmacy Permit [*] 60694-1803 ###-###-#### ###-###-#### fax
ATTACHMENT B Columbus, OH Coram Alternate Site Services DEA Registration [*] P.O. Box 74816 691 Greencrest Drive Federal Tax ID Number [*] Chicago, IL Westerville, OH 43081-2848 JCAHO Accreditation [*] 60694-4816 ###-###-#### Medicare - Part B [*] (614) 899-7919 fax National Association Boards of Pharmacy [*] Resident State Pharmacy Permit [*] Oklahoma City, OK Coram Alternate Site Services DEA Registration [*] P.O. Box ###-###-#### N.W. 2nd Street, #600 Federal Tax ID Number [*] Chicago, IL Oklahoma City, OK 73127 Home Health Agency License [*] 60694-4788 ###-###-#### JCAHO Accreditation [*] (405) 787-6018 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 [*] P.O. Box ###-###-#### S 108th E. Avenue, #284 Federal Tax ID Number [*] Chicago, IL Tulsa, OK 74146 Home Health Agency License [*] 60694-4788 ###-###-#### JCAHO Accreditation [*] (918) 665-2986 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 [*] P.O. Box ###-###-#### S.W. Durham Road Federal Tax ID Number [*] Chicago, IL Portland, OR 97224 JCAHO Accreditation [*] 60694-4805 ###-###-#### Medicare - Part B [*] (503) 684-6627 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 [*] P.O. Box 74792 230 Executive Drive, #126 Federal Tax ID Number [*] Chicago, IL Cranberry Township, PA 16066 Home Health Agency License [*] 60694-4792 ###-###-#### JCAHO Accreditation [*] (412) 772-3970 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 [*] P.O. Box ###-###-#### Flank Drive, #500 Federal Tax ID Number [*] Chicago, IL Harrisburg, PA 17112 Home Health Agency License [*] 60694-4775 ###-###-#### JCAHO Accreditation [*] (717) 540-7694 fax Medicare - Part B [*] National Association Boards of [*] Pharmacy Resident State Pharmacy Permit [*] - ---------------------------------------------------------------------------------------------------------------------------------- Philadelphia, PA Coram Alternate Site Services DEA Registration [*] P.O. Box 74775 6 Spring Mill Drive Federal Tax ID Number [*] Chicago, IL Malvern, PA 19355 Home Health Agency License [*] 60694-4775 ###-###-#### JCAHO Accreditation [*] (610) 889-0134 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 [*] P.O. Box 74822 20 Altieri Way, Unit 1 Federal Tax ID Number [*] Chicago, IL Warwick, RI ###-###-#### JCAHO Accreditation [*] 60694-4822 ###-###-#### Medicare - Part B [*] (401) 732-8209 fax National Association Boards of [*] Pharmacy Resident State Controlled Substance [*] Resident State Pharmacy Permit [*] - ----------------------------------------------------------------------------------------------------------------------------------
ATTACHMENT B Charleston, SC CHC of South Carolina DEA Registration [*] P.O. Box ###-###-#### Savage Road, Ste 500AA Federal Tax ID Number [*] Chicago, IL Charleston, SC 29407 JCAHO Accreditation [*] 60694-4768 ###-###-#### Medicare - Part B [*] (803) 769-4300 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 [*] P.O. Box 74777 Partnership 720 Gracern Road, #123 Federal Tax ID Number [*] Chicago, IL Columbia, SC 29210 Home Health Agency License [*] 60694-4777 ###-###-#### JCAHO Accreditation [*] (803) 731-4979 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. [*] P.O. Box 74768 Nursing Only 1200 Woodruff Road, Ste A-16 Federal Tax ID Number [*] Chicago, IL Greenville, SC 29607 Home Health Agency License [*] 60694-4768 ###-###-#### JCAHO Accreditation [*] (864) 458-9179 fax Medicare - Part A [*] Greenville, SC CHC of South Carolina DEA Registration [*] P.O. Box 74768 Pharmacy Only 1200 Woodruff Road, Ste A-16 Federal Tax ID Number [*] Chicago, IL Greenville, SC 29607 JCAHO Accreditation [*] 60694-4768 ###-###-#### Medicare - Part B [*] (864) 458-9179 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 [*] P.O. Box ###-###-#### Lark Street Federal Tax ID Number [*] Chicago, IL Johnson City, TN 37604 JCAHO Accreditation [*] 60694-4777 ###-###-#### Medicare - Part B [*] (423) 434-0095 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 [*] P.O. Box ###-###-#### Century Center Pkwy, #12 Federal Tax ID Number [*] Chicago, IL Memphis, TN 38134 JCAHO Accreditation [*] 60694-4777 ###-###-#### Medicare - Part B [*] (901) 388-3992 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 [*] P.O. Box 74770 618 Grassmere Park Dr, #7 Federal Tax ID Number [*] Chicago, IL Nashville, TN 37211 Medicare - Part B [*] 60694-4770 ###-###-#### National Association Boards of Pharmacy [*] (615) 832-0036 fax Non-Resident State Pharmacy Permit [*] Resident State Pharmacy Permit [*] Austin, TX Coram Alternate Site Services DEA Registration [*] P.O. Box ###-###-#### W. Braker Lane, #500 Federal Tax ID Number [*] Chicago, IL Austin, TX 78759 Home Health Agency License [*] 60694-4805 ###-###-#### JCAHO Accreditation [*] (512) 338-0713 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 [*] P.O. Box ###-###-#### North Hall Street, #1100 Federal Tax ID Number [*] Chicago, IL Dallas, TX 75219 Home Health Agency License [*] 60694-4762 ###-###-#### JCAHO Accreditation [*] (214) 443-0130 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. [*] P.O. Box ###-###-#### Remcon Circle, Ste A DEA Registration [*] Chicago, IL El Paso, TX 79912 Federal Tax ID Number [*] 60694-4805 ###-###-#### Home Health Agency License [*] (915) 581-9366 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 ###-###-#### Willowbend, #1010 Federal Tax ID Number [*] Chicago, IL Houston, TX 77054 Home Health Agency License [*] 60694-4770 ###-###-#### JCAHO Accreditation [*] (713) 667-9304 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 [*] P.O. Box ###-###-#### Data Point, #102 Home Health Agency License [*] Chicago, IL San Antonio, TX 78229 60694-4805 - ------------------------------------------------------------------------------------------------------------------------------------ Salt Lake City, UT CHC of Utah DEA Registration [*] P.O. Box ###-###-#### West 2240 South, Ste A Federal Tax ID Number [*] Chicago, IL Salt Lake City, UT 84119 Home Health Agency License [*] 60694-4845 ###-###-#### Medicare - Part B [*] (801) 973-9868 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. [*] P.O. Box ###-###-#### Concorde Parkway, #800 DEA Registration [*] Chicago, IL Chantilly, VA 22021 Federal Tax ID Number [*] 60694-4780 ###-###-#### Home Health Agency License [*] (703) 631-4060 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 ###-###-#### Robin Hood Road, #114 Federal Tax ID Number [*] Chicago, IL Norfolk, VA 23513 Home Health Agency License [*] 60694-4796 ###-###-#### JCAHO Accreditation [*] (804) 855-6485 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 [*] P.O. Box ###-###-#### 118th Avenue, SE, Suite 100 Federal Tax ID Number [*] Chicago, IL Bellevue, WA 98005 Home Health Agency License [*] 60694-4805 ###-###-#### JCAHO Accreditation [*] (425) 450-7003 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 [*] P.O. Box 74792 206 Roxalana Business Park Federal Tax ID Number [*] Chicago, IL Dunbar, WV 25064 JCAHO Accreditation [*] 60694-4792 ###-###-#### Medicare - Part B [*] (304) 768-0925 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 [*] P.O. Box 74894 Partnership 611 St. Joseph Avenue, S Wing Home Health Agency License [*] Chicago, IL Marshfield, WI 54449 Medicare - Part B [*] 60694-4894 ###-###-#### - ------------------------------------------------------------------------------------------------------------------------------------ Milwaukee, WI Coram Alternate Site Services Clinical Lab Improvement Waiver Cert [*] P.O. Box 74829 17012 DEA Registration [*] Chicago, IL W. Victor Road Federal Tax ID Number [*] 60694-4829 New Berlin, WI 53151 Home Health Agency [*] (414) 785-9318 JCAHO Accreditation [*] (414) 785-0925 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 DICKINSON 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 DICKINSON 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 DICKINSON 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 DICKINSON 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 NAVAAN [*] 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