Transition Agreement between Medicis Pharmaceutical Corporation and aaiPharma Inc. (January 28, 2005)
Medicis Pharmaceutical Corporation and aaiPharma Inc. entered into this agreement to manage the transition following the termination of their previous Development, Commercialization and License Agreement. The agreement outlines the return of work product to Medicis, the assignment of certain contracts from aaiPharma to Medicis, and mutual indemnification for liabilities related to these contracts. Medicis agrees to pay aaiPharma a specified sum and reimburse certain expenses. The agreement ensures a smooth transfer of rights and obligations, with both parties cooperating to obtain necessary consents and fulfill outstanding commitments.
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(a) | The Work Product pursuant to Section 1; | ||
(b) | The Transferred Contracts pursuant to Section 2; | ||
(c) | A quality control agreement, duly executed by AAI; and | ||
(d) | Such other agreements, consents, documents, instruments and writings as are reasonably requested by Medicis or otherwise required to be delivered by AAI at or prior to the Closing Date pursuant to this Agreement. |
(a) | The payments required to be made by Medicis to AAI pursuant to Sections 4.1 and 4.2; | ||
(b) | A quality control agreement, duly executed by Medicis; and | ||
(c) | Such other agreements, consents, documents, instruments and writings as are reasonably requested by AAI or otherwise required to be delivered by Medicis at or prior to the Closing Date pursuant to this Agreement. |
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(a) | AAI shall use the Active Ingredient already provided to it by Medicis to perform its obligations hereunder. Thereafter, Medicis shall, at its sole cost and expense, deliver the Active Ingredient to AAI in quantities agreed to between the Parties. All risk (other than arising from or in connection with AAIs or its employees, agents or subcontractors negligence or willful or reckless actions or misconduct), right, title and interest in and to the Active Ingredient shall at all times belong to and remain in Medicis. AAI shall only use the Active Ingredient received by it to perform the Services. AAI shall promptly notify Medicis in writing of any Active Ingredient that does not meet the specifications identified in Attachment I of Exhibit III, and AAI shall return such Active Ingredient in accordance with Medicis instructions to either Medicis or its designee at Medicis risk and expense. |
(b) | AAI shall not be responsible for any loss or damage to the Active Ingredient, except where such loss or damage occurs as a result of AAIs or its employees, agents or subcontractors negligence or willful or reckless actions or misconduct. In such circumstances, AAI shall promptly reimburse Medicis for the Reimbursable Value (as such term is defined in Exhibit III hereto) therefor. Except as otherwise provided herein, all other supplies and materials that are required for the Services shall be obtained by AAI. |
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(a) | contains obligations of confidentiality on such subcontractor no less protective of Medicis Confidential Information than the obligations of AAI under this Agreement, unless otherwise agreed to by Medicis in a signed writing; | ||
(b) | requires such subcontractor to enter in to a confidentiality agreement in the form attached as Exhibit IV hereto; | ||
(c) | shall include substantially the same terms as those appearing in Section 9 of the DCL Agreement Ownership of Work Product to ensure that Medicis obtains the same rights in the Work Product generated under such subcontractor agreement as those set forth in this Agreement; | ||
(d) | permits Medicis to exercise its inspection and audit rights pursuant to Section 12 Inspections and Audits hereof; and | ||
(e) | without Medicis prior written consent, does not impose any payment obligations and/or liability on Medicis. |
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(a) | by mutual agreement of the Parties; |
(b) | by either Party by written notice to the other upon the occurrence of either of the following events: |
(i) | either Party is in material breach of this Agreement and fails to cure such breach within *** after receipt of written notice from the other Party identifying the breach; | ||
(ii) | either Party enters into bankruptcy, whether voluntary or involuntary, has a receiver appointed, becomes insolvent, enters into any arrangement with its creditors, takes or suffers any similar action in consequence of debt or ceases or threatens to cease to carry on its business as usual or permits the entry of an order adjudicating it to be bankrupt or insolvent and such order is not discharged within ***; or | ||
(iii) | as permitted by Section 17.5 hereof. |
(c) | Any termination or expiration of this Agreement shall not affect any outstanding obligations or payments due hereunder prior to such termination or expiration, nor |
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shall it prejudice any other remedies that the Parties may have under this Agreement. |
(a) | *** | ||
(b) | *** | ||
(c) | *** |
aaiPharma
2320 Scientific Park Drive
Wilmington, NC 28405
Tel: ***
Fax: 910 ###-###-####
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aaiPharma
2320 Scientific Park Drive
Wilmington, NC 28405
Tel: ***
Fax: 910 ###-###-####
Medicis Pharmaceutical Corporation
8125 North Hayden Road
Scottsdale, AZ ###-###-####
Tel: ***
Fax: 602 ###-###-####
Medicis Pharmaceutical Corporation
8125 North Hayden Road
Scottsdale, AZ ###-###-####
Tel: ***
Fax: 602 ###-###-####
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MEDICIS PHARMACEUTICAL CORPORATION | ||||
By: | ||||
Name: | ||||
Title: | ||||
AAIPHARMA INC. | ||||
By: | ||||
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Title: | ||||
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WORK PLAN
WORK PLAN
WORK PLAN
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1. INTERPRETATION | ||
1.1 | Definitions. Capitalized terms used herein which are not defined shall have the meanings given to such terms in the Agreement. In addition, as used herein, the following capitalized terms shall have the meanings set forth below: |
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1.2 | Attachments. The following exhibits are attached to this Exhibit III and are incorporated in and are deemed to be an integral part hereof: |
Attachment A | - | Product List and specifications for Products and Active Materials | ||
Attachment B | - | Price List | ||
Attachment C | - | Stability Testing Procedures/Fee Schedule | ||
Attachment D | - | Lot Numbering and Expiration Dates |
2. | MANUFACTURE AND SUPPLY OF PRODUCTS | |
2.1 | Manufacture. |
(a) | From and after the Closing Date and until the later of (i) the date which is *** after the FDA Approval Date, or (ii) the New Site Approval Date (the Post-Launch Date), AAI shall manufacture and sell to Medicis, and Medicis shall be required to purchase from AAI, one hundred percent (100%) of Medicis required commercial supply, including bulk clinical supply and samples, of the Products. | ||
(b) | From and after: |
(i) | the Post-Launch Date and until and including the ***, AAI shall manufacture and sell to Medicis, and Medicis shall be required to purchase from AAI, not less than *** of the following: Medicis required commercial supply of the Products plus Alternate Supplier Products during such time period; | ||
(ii) | the *** and until and including ***, AAI shall manufacture and sell to Medicis, and Medicis shall be required to purchase from AAI, not less than *** of the following: Medicis required commercial supply of the Products plus Alternate Supplier Products during such time period; |
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(iii) | the *** and until and including ***, AAI shall manufacture and sell to Medicis, and Medicis shall be required to purchase from AAI, not less than *** of the following: Medicis required commercial supply of the Products plus Alternate Supplier Products during such time period; and | ||
(iv) | the *** and until and including ***, AAI shall manufacture and sell to Medicis, and Medicis shall be required to purchase from AAI, not less *** of the following: Medicis required commercial supply of the Products plus Alternate Supplier Products during such time period;] |
2.2 | Packaging. Medicis shall be solely responsible for the content of all labels, product inserts and other labelling (Labeling) and shall ensure that all such Labeling complies in all material respects with applicable law. AAI shall package the Products with Labeling as specified and approved by Medicis. Medicis may, in its sole discretion, make changes to Labeling for the Products, which changes shall be submitted by Medicis to all applicable governmental agencies and other third parties responsible for the approval of the Products, if required. AAIs name shall not appear on the Labeling or anywhere else on the Products unless required by a governmental authority or other applicable laws or regulations. | |
2.3 | Quality Control and Assurance. |
(a) | AAI shall manufacture and supply the Products in accordance with (i) the Specifications; (ii) the approved NDA; and (iii) the current Good Manufacturing Practices for manufacturing finished products specified by the FDA (collectively, GMPs). AAIs responsibilities and obligations with respect to the manufacture of Products as set forth in this Section 2.4(a) are hereinafter referred to as the AAI Manufacturing Requirements. | ||
(b) | AAI shall perform such quality control and quality assurance testing as is reasonably required by the Quality Control Agreement to ensure that the Products |
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comply with all of the AAI Manufacturing Requirements as of the date of shipment to Medicis. |
(c) | If the Products as manufactured by AAI do not satisfy its quality control and quality assurance testing obligations due to AAIs failure to produce the Products in accordance with the Quality Control Agreement, AAI shall, at its sole cost and expense, manufacture additional Products to replace such defective Products. In such circumstances, Medicis shall have no obligation to purchase or pay for any rejected Products that are defective, unless and only to the extent that such Product is used by Medicis for another purpose, in which event Medicis shall only be required to pay for that portion of the rejected Products which it actually so uses. | ||
(d) | The Parties hereto agree that except in the circumstances where AAI has failed to comply with the AAI Manufacturing Requirements, AAI shall not be liable or have any responsibility for any deficiencies with respect to the Labeling and procedures specified by Medicis, sales and marketing of the Products or distribution of the Products. | ||
(e) | AAI shall provide Medicis with a certificate of conformance, a certificate of analysis, and copies of the batch record, any deviation and investigation reports, and Labeling prior to shipping Products to Medicis. The certificate of analysis will set out the actual test results for each lot of Products, and will certify that the Products shipped to Medicis have been evaluated by AAIs Quality Control/Quality Assurance department and that the Products comply with the Specifications. Medicis shall issue a formal QA release prior to the shipment of product by AAI. |
2.4 | Delivery. All Product(s) shall be delivered F.O.B. from AAIs manufacturing facility. Medicis shall be responsible for arranging the shipment of the Product(s) from AAIs manufacturing facility to its final destination. All shipping costs and taxes associated with the sale to Medicis of Products hereunder will be for the account and expense of Medicis. | |
2.5 | Rejection of Products. |
(a) | Medicis shall inspect the Products manufactured by AAI within *** after receipt thereof and shall give AAI written notice (a Deficiency Notice) of all Shortages and obvious damage to or defects in the delivered Products, prior to the expiry of *** day period, except that Medicis shall give AAI a Deficiency Notice of any non-obvious defects, including failure to meet Specifications, within *** following discovery thereof. Except as set forth in Section 4.2 below, AAI shall have no liability for any Shortages or defects for which it has not received a Deficiency Notice within such ***. | ||
(b) | A Deficiency Notice pursuant to this Section 2.5 shall describe the deficiency in such detail as to reasonably inform AAI of its nature and basis. Thereafter, upon |
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request, Medicis shall provide AAI with all information and documentation reasonably requested by AAI in order to evaluate the Deficiency Notice. AAI shall have a period of *** after its receipt of a Deficiency Notice to present in writing to Medicis any objections AAI may have to the matters set forth therein. If no objections are raised within such ***, the Deficiency Notice shall be deemed final and accepted and approved by AAI on such ***. If AAI shall raise any objections, Medicis and AAI shall attempt to resolve the matters in dispute, and if resolved, the Parties shall accordingly revise the Deficiency Notice and the Deficiency Notice as so revised shall become final. If such dispute cannot be resolved by the Parties within *** after delivery of the Deficiency Notice to AAI, then, upon *** prior written notice to the other party, the matters in dispute shall be submitted to Boston Analytical, Inc. of Salem, New Hampshire, unless objected to by either party within the *** notice period, or such other laboratory as agreed to in writing by the Parties (in either case, the Laboratory), which Laboratory shall make a final and binding determination as to such matters. The expenses associated with such dispute determination by the Laboratory shall be borne by the Party whose position was not substantiated by such firm. |
(c) | To the extent that a deficiency is set forth in a final Deficiency Notice, AAI shall, as soon as is commercially reasonable but in no event later than *** after the Deficiency Notice becomes final in accordance with Section 2.6(b) hereof, supply Medicis with Product conforming to the Specifications in an amount equal to the deficiency, and reimburse Medicis for all Active Materials consumed in the production of such Product, at the Reimbursable Value. |
2.6 | Manufacturing-Related Services. |
(a) | Upon the written request of Medicis, AAI shall conduct stability testing on the Products in accordance with the protocols submitted by Medicis and a Service Estimate to be agreed to between the Parties, the particulars of which will be incorporated into Attachment C hereto once agreed to and executed by the Parties. AAI shall not make any changes to the testing procedures without prior written approval from Medicis. In the event that any lot of Products fails stability testing, AAI and Medicis shall jointly determine the proceedings and methods to be undertaken to investigate the causes of such failure, including which Party shall bear the cost of such investigation. AAI shall not be liable for any costs of such investigation, unless there has been a breach by AAI of the AAI Manufacturing Requirements. In the event of a breach by AAI of the AAI Manufacturing Requirements, AAI shall promptly reimburse Medicis for (a) Medicis actual costs with respect to the Active Materials delivered by Medicis to AAI in the manufacture of such Products, and (b) the purchase price paid for any batches of Products which fail stability testing as a result of AAIs breach. AAI will provide Medicis with any and all data and results relating to the stability testing in accordance with the Quality Control Agreement. From time to time, AAI may, at the request of Medicis, also provide Medicis with stability testing services with respect to products not manufactured by AAI, the cost of such services to be agreed to between the Parties prior to such services being undertaken. Medicis |
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reserves its right to use an alternative second source of stability testing at any time. |
2.6.2 | The pricing contained in Attachment B does not apply to manufacturing-related services set forth in Service Estimates. |
2.7 | Manufacturing Changes. Except with respect to the New Manufacturing Site and as provided in the Quality Control Agreement, AAI shall not make any change in the manufacturing site of the Products or make any change to the manufacturing equipment or manufacturing process of the Products without having such changes approved in writing by Medicis prior to implementation. Medicis may not unreasonably withhold or delay such approval. Both Parties will establish a change control procedure. |
3. | ORDERS, DELIVERY, INVOICING AND PAYMENT | |
3.1 | Yearly Forecasts. On the Closing Date, Medicis shall provide AAI with a forecast of the volume of each Product required during the first year of the Agreement. Medicis shall provide AAI with rolling forecasts of the volume of each Product required during the next *** months (or such shorter period if expiration of the Term shall be less than *** months from the date of such forecasts). Such rolling quarterly volume forecasts shall (i) be updated by Medicis by the 15th day of every month with respect to the next full ***; (ii) with respect to the first *** months of such forecasts, be a binding commitment that Medicis is obligated to order and purchase from AAI as forecasted and shall not be subject to reduction (Binding Order); and (iii) with respect to all periods other than the *** of such forecasts subject to the Binding Order, be updated as soon as practicable by Medicis upon its determination that the volumes contemplated in the most recent of such forecasts have changed by *** or more. | |
3.2 | Written Orders. The written Binding Orders submitted by Medicis to AAI pursuant to Section 3.1(ii) hereof shall specify Medicis purchase order number, quantities by Product type, monthly pick-up schedule and any other elements reasonably necessary to ensure the timely production of the Products. | |
3.3 | Packaging and Raw Materials. All Components shall be purchased (with the exception of those which are supplied by Medicis), and tested in accordance with the Quality Control Agreement, by AAI at AAIs expense to ensure that such Components meet any Specifications. Amendments to such Specifications requested by Medicis will only be implemented with the approval of AAI following a technical and cost review, such approval not to be unreasonably withheld but being subject to Medicis and AAI reaching agreement as to price revisions necessitated by any such amendment in accordance with Section 3.7 below. | |
3.4 | Change in Specifications. |
(a) | If Medicis requests a change in the manufacturing process, Specifications or Labeling which would result in an increase in AAIs costs for Components, the Parties shall discuss what impact, if any, such change should have on the price of the Products. Unless otherwise agreed by the Parties, any and all direct costs |
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associated with Specification changes, including changes requested by Medicis or required by applicable law, shall be borne by Medicis. The price change shall become effective only with respect to those orders of Products which are manufactured in accordance with the revised Specifications. | |||
(b) | Notwithstanding any change in the Specifications implemented in accordance with the terms of Section 3.4(a) above, Medicis agrees to purchase all Products manufactured by AAI and ordered by Medicis based upon any old Specifications at the then-current price for those Products. In addition, Medicis agrees to purchase, at AAIs out-of-pocket cost, all Inventory, defined as the finished product, raw materials and components, utilized under the old Specifications and purchased or maintained by AAI in order to fill firm written orders (including a Binding Order), to the extent that such Inventory can no longer be utilized under the revised Specifications. Medicis shall reimburse AAI for any out-of-pocket costs associated with destruction of such obsolete Inventory or Active Materials. Open purchase orders for Components no longer required under any revised Specifications which were placed by AAI with suppliers in order to fill firm written orders (including a Binding Order) shall be cancelled where possible, and where such orders are not subject to cancellation without penalty, such orders shall, at AAIs election, either (i) be cancelled, with Medicis paying the penalty; or (ii) be assigned to and satisfied by Medicis. |
3.5 | Invoices and Payment. Except as otherwise provided in this Exhibit III, AAI shall charge Medicis for only those Products that are released by Medicis in accordance with the terms hereof, including Section 2.5 hereof. AAI shall submit to Medicis, with each such shipment of Products, an invoice covering such shipment. AAI shall also provide Medicis with an invoice covering any Inventory or Components purchased by Medicis from AAI in accordance with the terms of this Exhibit III. Each such invoice shall, to the extent applicable, identify the Medicis purchase order number, Product numbers, names and quantities, unit price, freight charges and the total amount to be remitted by Medicis. Medicis shall pay all such invoices within *** of the receipt thereof. | |
3.6 | Lot Numbering/Expiration Dates. AAI shall make arrangements for and implement the imprinting of lot numbers and expiration dates for each Product shipped. Such lot numbers and expiration dates shall be affixed on the Products and on the shipping carton of each product as is required by GMPs. The system used by AAI for lot numbering and expiration dates is detailed on Attachment D hereto. | |
3.7 | No Guarantee: Except as expressly provided in this Exhibit III, AAI acknowledges that there are no guaranteed volumes of the Products. | |
4. | CO-OPERATION | |
4.1 | Records and Accounting by AAI. AAI shall keep records of the manufacture, testing and shipping of the Products, and retain samples of such Products that are necessary to comply with FDA manufacturing requirements and AAI Manufacturing Requirements as well as to assist with resolving product complaints and other similar investigations. |
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Copies of such records and samples shall be made available to Medicis upon its reasonable request and shall be retained by AAI and be available to Medicis for a period of *** following the date of manufacture, or *** past expiry or longer if required by law. | ||
4.2 | Product Recalls. |
(a) | AAI and Medicis shall each maintain records as may be necessary to permit a recall or a field correction of any the Products delivered to Medicis or customers of Medicis, effected voluntarily or under a threat of, or a directive by, any governmental agency. Each Party shall give immediate notice by telephone (to be confirmed in writing) to the Director of Quality Control/Quality Assurance of the other Party upon discovery that any Products should be recalled or corrected, or may be required to be recalled or corrected, and, each Party upon receiving any such notice or upon any such discovery, shall evaluate the need to cease and desist from further shipments of such Products in its possession or control until a decision has been made whether a recall or some other corrective action is necessary. The decision to initiate a recall or to take some other corrective action, if any, shall be made and implemented by Medicis. AAI will co-operate as reasonably required by Medicis, having regard to all applicable laws and regulations. Each Party shall co-operate with the other in developing any necessary recall plan, and the manner and extent of such plan shall be subject to prior consultation, which consultation shall not unreasonably delay such plan. | ||
(b) | To the extent that a recall results from, or arises out of, any breach by AAI of the AAI Manufacturing Requirements then (i) AAI shall reimburse Medicis for Medicis documented out-of-pocket, direct costs and expenses arising from the recall, and (ii) AAI shall replace the recalled Products with new Products as soon as commercially reasonable, contingent upon the receipt or availability from Medicis of all Active Materials; provided, however, that if AAI shall have all of the Components and Active Materials necessary to manufacture the Products on its premises, then AAI shall begin manufacturing to replace the recalled Products with new Products within *** following the resolution of all issues related to such recall. AAIs cost for such Active Materials lost as a result of any breach by AAI of the AAI Manufacturing Requirements shall be limited to the Reimbursable Value thereof. In the event that (x) AAI is unable to replace the recalled Products within the time period required by the immediately preceding sentence (except where such inability results from a failure to receive the required Active Materials, Components or a Force Majeure event), or (y) such new Products are also recalled or returned due to a breach by AAI of the AAI Manufacturing Requirements, then AAI shall reimburse Medicis for the purchase price that Medicis paid AAI for the returned inventory of the affected Products. Medicis shall be responsible for all costs and expenses associated with a recall or corrective action that does not result from, or arise out of, a breach by AAI of the AAI Manufacturing Requirements. |
4.3 | Governmental Agencies. Medicis shall have sole responsibility for obtaining any and all necessary regulatory approvals from the FDA for modifications to the manufacturing |
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process, Specifications and NDA and for reporting any modifications to such manufacturing process, Specifications or the NDA to the FDA as appropriate. |
4.4 | Customer Questions and Complaints. Medicis shall have the sole responsibility for responding to questions and complaints from Medicis customers. Questions or complaints received by AAI from Medicis customers shall be promptly referred to Medicis. AAI shall co-operate as reasonably required to allow Medicis to determine the cause of and resolve any customer questions and complaints. Such assistance shall include follow-up investigations including testing. In addition, within ten (10) days from the date of request, AAI shall provide Medicis with all available information that will assist Medicis in responding to questions or complaints relating to the Products. All costs incurred in respect of this Section 4.4 shall be borne by the respective Parties who incurred such costs. Medicis shall fax product complaints to AAI within *** after Medicis confirms such complaint to: |
Attention: Corporate Quality
2320 Scientific Park Dr.
Wilmington, NC 28405
5. | TERM | |
5.1 | Term. The term of the terms and conditions of this Exhibit III shall commence on the Closing Date and continue for the term described in Section 16.1 of the Agreement, unless terminated as provided therein or in Section 2.1(b) hereof or extended for such period of time as the parties hereto shall mutually agree to in writing (the Term). | |
6. | REPRESENTATIONS AND WARRANTIES | |
6.1 | Formulas and Trademarks. Medicis represents and warrants that the Specifications for each of the Products are its property and that Medicis may lawfully disclose the Specifications to AAI. Medicis further represents and warrants that any trademarks it authorizes to be utilized by AAI in connection with any of the Products, including the Trademarks, are its property and may be lawfully used as directed by Medicis. Medicis further represents and warrants that the Specifications for all Products conform in all material respects to all applicable laws and regulations, and that the Products if labelled and formulated in accordance with the Specifications and manufactured in compliance with applicable GMPs may be lawfully sold and distributed in every jurisdiction in which Medicis markets such Products and Medicis will sell and distribute in compliance with applicable laws. | |
7. | PRICE | |
7.1 | Price. The prices for the Products are shown in Attachment B hereto and incorporated herein by reference. In addition, Medicis shall be responsible for the payment of any and all sales and use taxes applicable to the Products and services described herein. The prices may be adjusted by AAI on the anniversary of the first firm order by Medicis, and |
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annually thereafter by the total percentage change in the price of the Product as reflected in the *** over the preceding ***. AAI shall notify Medicis of such increase within *** days of the price change date. |
8. | MISCELLANEOUS | |
8.1 | Permits. AAI shall, at its own expense, obtain and maintain the necessary permits required for the manufacture and supply of the Products, provided that AAI shall not be responsible for obtaining or maintaining any other permits or other regulatory approvals in respect of the Products or the Specifications, which shall be the sole responsibility of Medicis. | |
8.2 | Trademarks. Medicis and AAI hereby acknowledge that neither Party has, nor shall it acquire, any interest in any of the other Partys copyrighted material, trademarks, trade names or other intellectual property unless otherwise expressly agreed to in writing. The Parties agree not to use any trademark or trade name of the other Party, except as specifically authorized by the other Party. | |
8.3 | Reports. AAI will supply on an annual basis, Product data, including release test results, complaint test results and all investigations (in manufacturing, testing and storage) directly related to the Product and AAIs ability to produce the Products in accordance with all applicable laws, and will also prepare and complete the full Annual Product Review, which Medicis will then review before preparing the Annual Report with the FDA. If Medicis reasonably finds the Annual Product Review non-conforming, AAI shall prepare an appropriate revision. | |
8.4 | Additional Product. The Parties covenant and agree that additional products may be added to Attachment A hereto and such additional products shall be governed by the general conditions hereof with any special terms (including, without limitation, price) governed by an addendum hereto. |
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Product | Fill | Annual | Run | Unit Price | ||||||||||||
Description | Size | Quantity | Quantity | (USD) | ||||||||||||
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1. | COMPANY shall disclose and/or authorize disclosure through designated representatives to RECIPIENT all relevant Confidential Information as deemed necessary by COMPANY to facilitate RECIPIENTS ability to perform its functions and obligations as a subcontractor to |
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COMPANY. RECIPIENT shall accept and hold such Confidential Information in confidence in accordance with the provisions hereof. |
2. | Without the prior written consent of COMPANY, RECIPIENT shall neither (i) disclose, directly or indirectly, to any third party or permit any third party to have access to any of MEDICIS Confidential Information disclosed to RECIPIENT by COMPANY, nor (ii) use, directly or indirectly, such Confidential Information for any purpose other than as set forth herein. However, the aforesaid obligations of confidentiality assumed by RECIPIENT shall not apply to any Confidential Information that RECIPIENT can clearly demonstrate falls within any of the following categories: |
(a) | Confidential Information that is now generally known to the public in an integrated written form or subsequently becomes generally known to the public in an integrated written form through no fault of RECIPIENT or breach of any other confidentiality obligation owed to COMPANY or MEDICIS; | ||
(b) | Confidential Information that, as of the time of disclosure to RECIPIENT, was already known to and in the possession of RECIPIENT as evidenced by written records and not otherwise subject to a confidentiality obligation; or | ||
(c) | Confidential Information obtained after the date hereof by RECIPIENT from a third party lawfully in possession of, and having the right to disclose same. |
3. | For purposes of keeping Confidential Information confidential, the RECIPIENT shall use efforts at least commensurate with those employed by RECIPIENT for the protection of its own Confidential Information, but the use of such efforts shall not constitute a defense in the event that any of the Confidential Information is not kept confidential in accordance with the terms of this Agreement. The RECIPIENT shall take all reasonable measures including, but not limited to, court proceedings, at its own expense, to restrain consultants, agents, associates, employees or former employees from unauthorized use or disclosure of Confidential Information and RECIPIENT shall be liable to COMPANY and/or MEDICIS for any damages resulting from the breach by any of RECIPIENTS consultants, agents, associates, employees or former employees of the terms hereof. RECIPIENT acknowledges that in the event of a breach of this Agreement, both COMPANY and MEDICIS may suffer irreparable damage that may not be fully remedied by monetary damages. RECIPIENT therefore agrees that COMPANY, or MEDICIS, or both of them shall be entitled to seek injunctive relief against any such breach in any court of competent jurisdiction. COMPANYs and MEDICIS rights under this Section 3 shall not in any way be construed to limit or restrict their rights to seek other damages or relief available under this Agreement or applicable law. |
4. | Except as may otherwise be expressly set forth in an agreement between the parties hereto entered into after the date hereof, neither COMPANY nor RECIPIENT make and shall not be deemed to make or have made any representation or warranty as to the accuracy or completeness of the Confidential Information or any part thereof. |
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5. | Except as provided in Section 1 hereof, no license or other right to use the Confidential Information is granted hereby. |
6. | The disclosure of Confidential Information by COMPANY to RECIPIENT shall not result in any obligation on the part of either party to enter into any future agreement relating to the Confidential Information or to undertake any other obligation not set forth in written agreement signed by the parties hereto. |
7. | Confidential Information furnished by COMPANY to RECIPIENT under this Agreement shall remain COMPANYs or MEDICIS property, and any document or recording/reproduction containing such Confidential Information in written or other form shall be promptly returned to COMPANY or MEDICIS upon request. Return or destruction of Confidential Information of documents or other tangible things which embody or record the Confidential Information does not affect the continuing obligations of the RECIPIENT under this Agreement. |
8. | RECIPIENT acknowledges that any work product (including but not limited to data, reports including case reports and case report forms, interpretations, opinions and recommendations), trade secret information, copyrightable work product and any and all other intellectual property rights developed, derived from or otherwise generated by RECIPIENT, directly or indirectly, from the Information shall be owned by and belong exclusively to COMPANY. Further, RECIPIENT agrees to treat such work product or information as Confidential Information subject to the confidentiality, nonuse and nondisclosure obligations hereunder. RECIPIENT agrees to promptly and fully disclose such work product or information to COMPANY. RECIPIENT hereby assigns and agrees to assign to COMPANY the ownership right, title, and interest in such material, including, without limitation, inventions (whether patentable or unpatentable), and copyrightable work product and COMPANY shall have the right to obtain and hold in its own name, without obligation of any kind to RECIPIENT, patents, copyrights, or other protection which may be available or become available with respect to such items. RECIPIENT further agrees to give COMPANY and its designees or assignees all assistance reasonably required to perfect such rights, titles and interests. These obligations shall survive and continue beyond the termination of this Agreement and shall be binding upon RECIPIENTs assigns, executives, administrators and other legal representatives. |
9. | With the exception of personal and confidential patient medical records, all case report forms and other reports and data generated during the course of any study performed by RECIPIENT as a subcontractor to COMPANY between the parties shall be the sole property of COMPANY. Such data may be used by COMPANY or MEDICIS for any purpose without further obligation or liability to the RECIPIENT, unless otherwise agreed to in writing by the parties. |
10. | RECIPIENT represents and warrants that it is not now nor shall it be a party to any other agreement or under any obligation to or restriction by any third party which would prevent the RECIPIENT from entering into this Agreement or which would conflict with any of its obligations under this Agreement or any of the undertakings set forth herein in any manner. |
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11. | Neither party hereto shall be entitled to assign its rights hereunder without the express written consent of the other party, except that COMPANY may assign it rights under this Agreement to MEDICIS. | |
12. | A waiver by either party of any term or condition of this Agreement in any instance shall not be deemed or construed to be a waiver of such term or condition for the future, or of any subsequent breach thereof. All rights, remedies, undertakings, or obligations contained in this Agreement shall be cumulative and none of them shall be in limitation of any other right, remedy, undertaking, or obligation of either party. | |
13. | If and to the extent that any court of competent jurisdiction holds any provision or part of this Agreement to be invalid or unenforceable, the remainder of this Agreement shall be construed and reformed so as to as to as nearly as possible give effect to the intentions of the parties in entering in to this Agreement, and to as completely as possible protect the confidentiality of MEDICIS Confidential Information. | |
14. | In the event that RECIPIENT becomes legally compelled to disclose any of the Confidential Information, RECIPIENT shall give COMPANY prompt notice so that they may seek a protective order or other appropriate remedy or waive compliance with the provisions of this Agreement. In the event that such protective order or other remedy is not obtained, or the COMPANY waives compliance with the provisions of this Agreement, RECIPIENT shall furnish only that portion of the Confidential Information which is legally required to be disclosed. | |
15. | Without the prior written consent of COMPANY, RECIPIENT shall not disclose to any person or entity (a) the terms of its engagement involving COMPANY, MEDICIS and RECIPIENT, (b) that RECIPIENT has requested or received any Confidential Information, or (c) any of the terms, conditions or other facts with respect to any work performed by RECIPIENT as a subcontractor to COMPANY, including the status thereof. | |
16. | This Agreement shall be construed in accordance with and governed by the laws of the State of Delaware without regard to that States conflict-of-laws rules or principles requiring the application of the laws of another jurisdiction. MEDICIS is an express third party beneficiary of this Agreement, with full rights to enforce the provisions hereof as if a party hereto. | |
17. | This Agreement contains the entire understanding between the parties with respect to the matters contemplated herein and supersedes all previous written and oral negotiations, commitments, and understandings. This Agreement cannot be altered or otherwise amended except pursuant to an instrument in writing signed by each of the parties hereto and making specific reference to this Agreement. |
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COMPANY | RECIPIENT | |||||
By: | By: | |||||
Name: | Name: | |||||
Title: | Title: | |||||
5
Area of Responsibility | AAI | Medicis | ||
Quality Assurance | *** | *** | ||
Regulatory Affairs | *** | *** | ||
Technical Services | *** | *** | ||
Medical Affairs | *** | *** | ||
Non-medical Product Complaints | *** | TBD |
* | Key Quality Assurance contact |
Page 1 of 13
1. | The term of this QT Agreement will begin on the Effective Date (see 3. below) and will expire on the date of expiration or earlier termination of the Manufacturing Terms. | ||
2. | The parties will review this QT Agreement at least annually to verify that the technical responsibilities allocated in this QT Agreement are current and valid. | ||
3. | The Effective Date of this QT Agreement will be the signature date of the last party to sign this QT Agreement. The QT Agreement shall be fully implemented within thirty (30) days of the Effective Date. |
Either party may propose updates, amendments, modifications, or supplements (collectively, the Amendments) to this QT Agreement. No Amendment will be valid or effective unless made in writing and signed by duly authorized officers of both parties. |
Page 2 of 13
NO. | RESPONSIBILITIES | N/A | Medicis | AAI | ||||||
1 | COMPLIANCE REQUIREMENTS | |||||||||
1.1 | Perform and maintain all audit documentation regarding supplier(s) of Active Ingredient for the Products. | *** | *** | *** | ||||||
1.2 | Perform and maintain all qualification documentation regarding suppliers of Components for the Products. | *** | *** | *** | ||||||
1.3 | Manufacture, test and package Product in strict adherence to the approved drug application, cGMPs, and Specifications. | *** | *** | *** | ||||||
1.4 | *** shall not to subcontract any of the work to a third party without prior written agreement of ***, which prior agreement shall not be unreasonably withheld or delayed. *** shall be responsible for auditing subcontractors to ensure cGMP compliance. | *** | *** | *** | ||||||
1.5 | Provide *** with copies of all information supporting annual Product reports for Products supplied to Medicis. | *** | *** | *** | ||||||
1.6 | Provide *** with copies/correspondence regarding the approved drug applications for the Products. | *** | *** | *** | ||||||
1.7 | Notify *** and have written authorization from *** prior to implementing any proposed changes to the facilities, manufacturing process, materials, Specifications, and/or testing that impact the approved registration, or that require revalidation. Identify for ***, in writing prior to delivery, the first manufactured Batch incorporating any approved changes. | *** | *** | *** | ||||||
1.8 | Provide notification to the other party of any organizational and/or personnel changes to Quality Assurance, Technical Services, or Regulatory Affairs Contacts. | *** | *** | *** | ||||||
1.9 | *** will make every reasonable effort to provide copies of any Form 483s, Warning Letters, Field Alerts or similar correspondence from Governmental Authorities within one (1) business day of receipt and subsequent responses(s) relating to the Products or processes used to produce, test, or package the Products promptly thereafter. *** approval is required for responses related to the Products. | *** | *** | *** |
Page 3 of 13
NO. | RESPONSIBILITIES | N/A | Medicis | AAI | ||||||
1.10 | Notify *** within one (1) business day of any circumstances likely to result in a recall, Product withdrawal or field correction, including any confirmed Product failure. | *** | *** | *** | ||||||
1.11 | Perform and maintain as current all appropriate validation, including but not limited to: process, analytical method, cleaning, computer, and packaging. | *** | *** | *** | ||||||
1.12 | Dispose of all production residue, manufacturing rejects, tailings, other chemicals, containers and packaging materials associated with Products manufactured for Medicis in compliance with all applicable laws and regulations. | *** | *** | *** | ||||||
1.13 | *** will notify *** within (2) two business days, then proceed to promptly investigate and resolve to the reasonable satisfaction of *** all Out-of-Specification results. *** to review and approve any retesting scenarios in OOS investigations. | *** | *** | *** | ||||||
1.14 | Notify *** of any requests for information, notices of violations or other communication from a Governmental Agency related to the Medicis Products or processes promptly within no more than two (2) business days after *** receipt thereof. | *** | *** | *** | ||||||
1.15 | Notify *** of any incident affecting compliance to environmental, occupational health and safety laws related to handling *** Products or processes within three (3) business days. | *** | *** | *** | ||||||
2 | PRODUCTION AND TESTING OF BULK PRODUCT | |||||||||
2.1 | *** to Maintain the Master Formula (or Product structure). *** to review and approve. | *** | *** | *** | ||||||
2.2 | *** will maintain approved Specifications. | *** | *** | *** | ||||||
2.3 | Provide consistent Batch identification system for bulk manufacture. Immediately notify *** of any proposed changes to identification system prior to implementation of any such changes. | *** | *** | *** |
Page 4 of 13
NO. | RESPONSIBILITIES | N/A | Medicis | AAI | ||||||
2.4 | Qualify Active Ingredient suppliers. | *** | *** | *** | ||||||
2.5 | Maintain Active Ingredient Specification, and ensure compliance of the Specification with regulatory and compendial requirements. | *** | *** | *** | ||||||
2.6 | Procure Active Ingredient (include Certificate of Analysis, COA, for the Active Ingredient). The Active Ingredient shall have not less than *** left to expiration upon receipt at AAI. Any exceptions to the above must be approved in writing by AAI. | *** | *** | *** | ||||||
2.7 | Store Active Ingredient. | *** | *** | *** | ||||||
2.8 | Sample Active Ingredient. | *** | *** | *** | ||||||
2.9 | Validate and/or transfer test method for Active Ingredient to AAI. *** to approve the analytical method. | *** | *** | *** | ||||||
2.10 | Analyze Active Ingredient (include documentation, COA). | *** | *** | *** | ||||||
2.11 | Release Active Ingredient. | *** | *** | *** | ||||||
2.12 | Retain reference samples of Active Ingredient for a minimum of *** beyond Product expiration date, of the last lot using each batch of API. | *** | *** | *** | ||||||
2.13 | Qualify inactive substance suppliers in accordance with AAI policies. Qualification does not include on-site audits. | *** | *** | *** | ||||||
2.14 | Procure inactive substances (include COA). | *** | *** | *** | ||||||
2.15 | Store inactive substances. | *** | *** | *** | ||||||
2.16 | Sample inactive substances. | *** | *** | *** | ||||||
2.17 | Validate and/or transfer test methods for the inactive substances to ***. | *** | *** | *** | ||||||
2.18 | Analyze inactive substances (include documentation, COA). | *** | *** | *** | ||||||
2.19 | Release inactive substances. | *** | *** | *** | ||||||
2.20 | Perform Process Validation. *** to review and approve. | *** | *** | *** |
Page 5 of 13
NO. | RESPONSIBILITIES | N/A | Medicis | AAI | ||||||
2.21 | Perform Cleaning Validation. *** to review and approve. | *** | *** | *** | ||||||
2.22 | Provide Bill of Materials (BOM) for bulk manufacture. *** to review and approve. | *** | *** | *** | ||||||
2.23 | Provide Manufacturing Transfer Document for transfer within ***. *** to review and approve. | *** | *** | *** | ||||||
2.24 | Prepare Manufacturing Instructions (Production Operating Instructions). *** to review and approve. | *** | *** | *** | ||||||
2.25 | *** will maintain Specification for bulk Product and ensure compliance of the Specification with regulatory and compendial requirements. *** will maintain approved Specifications. | *** | *** | *** | ||||||
2.26 | Produce bulk Product (include Batch documentation). | *** | *** | *** | ||||||
2.27 | Document, investigate and resolve deviations from approved manufacturing instructions or Specifications. *** to review and approve all deviations. *** to be notified within (2) two business days of discovery of a deviation. | *** | *** | *** | ||||||
2.28 | Not to reprocess or salvage any partially processed or fully processed materials without the written consent of *** unless such activities are expressly allowed in applicable approved regulatory documents. | *** | *** | *** | ||||||
2.29 | Develop bulk Product sampling plan. *** to review and approve. | *** | *** | *** | ||||||
2.30 | Sample bulk Product. | *** | *** | *** | ||||||
2.31 | Validate and/or transfer test method for bulk Product to ***. *** to approve analytical method. | *** | *** | *** | ||||||
2.32 | Analyze bulk Product. | *** | *** | *** | ||||||
2.33 | Approve bulk Product for packaging. | *** | *** | *** | ||||||
2.34 | Produce Certificate of Analysis for bulk Product. | *** | *** | *** |
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NO. | RESPONSIBILITIES | N/A | Medicis | AAI | ||||||
2.35 | Retain reference samples of bulk Product for the period of time specified in AAIs Standard Operating Procedures. | *** | *** | *** | ||||||
2.36 | Perform manufacturing facility, equipment and instrument qualification, preventive maintenance and calibration. | *** | *** | *** | ||||||
2.37 | Perform laboratory facility, equipment and instrument qualification, preventive maintenance and calibration. | *** | *** | *** | ||||||
2.38 | Perform stability storage and testing of bulk Product. | *** | *** | *** | ||||||
3. | INSPECTION, PACKAGING OF FINISHED PRODUCT | |||||||||
3.1 | Maintain finished Product Specification, and ensure compliance of the Specifications with regulatory and compendial requirements. | *** | *** | *** | ||||||
3.2 | Provide Batch identification system for finished Product. | *** | *** | *** | ||||||
3.3 | Provide artwork and labeling text (blister, carton, leaflet, label, etc.) to ***. | *** | *** | *** | ||||||
3.4 | Perform labeling review and approval. | *** | *** | *** | ||||||
3.5 | *** will provide Specifications for packaging materials, and ensure compliance of the Specifications with regulatory and compendial requirements. *** will maintain approved Specifications. | *** | *** | *** | ||||||
3.6 | Validate and/or transfer test method(s) for Product packaging materials to ***. *** to approve analytical methods. | *** | *** | *** | ||||||
3.7 | Qualify packaging component and labeling suppliers in accordance with AAI policies. Qualification does not include on-site audits. | *** | *** | *** | ||||||
3.8 | Procure packaging materials. | *** | *** | *** | ||||||
3.9 | Analyze packaging materials. | *** | *** | *** | ||||||
3.10 | Release packaging materials. | *** | *** | *** |
Page 7 of 13
NO. | RESPONSIBILITIES | N/A | Medicis | AAI | ||||||
3.11 | Retain samples of labeling materials for a minimum of *** past Product expiry date. [NOTE: Other packaging materials need not be retained separately since they are part of the finished Product retains]. | *** | *** | *** | ||||||
3.12 | Perform Packaging Validation. *** to review and approve. | *** | *** | *** | ||||||
3.13 | *** will provide Bill of Materials (BOM) for packaging. *** to review and approve. | *** | *** | *** | ||||||
3.14 | *** will prepare Packaging Instructions (Production Operating Instructions for packaging). *** to review and approve. | *** | *** | *** | ||||||
3.15 | Perform packaging operations (include documentation). | *** | *** | *** | ||||||
3.16 | Perform in-process controls during packaging (include documentation). | *** | *** | *** | ||||||
3.17 | Develop finished Product sampling plan consistent with the Manufacturing Terms for retain and stability samples. Provide finished Product release sampling plan for *** review and approval. | *** | *** | *** | ||||||
3.18 | Sample finished Product including retain samples, stability samples, release samples, and customer samples. | *** | *** | *** | ||||||
3.19 | Retain reference samples of finished Product for a minimum of one *** past Product expiry date. | *** | *** | *** | ||||||
3.20 | Reconcile packaging materials. | *** | *** | *** | ||||||
3.21 | Perform manufacturing facility, equipment and instrument qualification, preventive maintenance and calibration. | *** | *** | *** | ||||||
3.22 | Perform laboratory facility, equipment and instrument qualification, preventive maintenance and calibration. | *** | *** | *** | ||||||
3.23 | Document, investigate and resolve any deviations from approved packaging instructions or Specifications. *** to review and approve all deviations. Notify *** within (2) two business days of discovery of deviations. | *** | *** | *** |
Page 8 of 13
NO. | RESPONSIBILITIES | N/A | Medicis | AAI | ||||||
4. | TESTING AND RELEASE OF FINISHED PRODUCT | |||||||||
4.1 | Validate and/or transfer test method(s) for finished Product to ***. *** to review and approve. | *** | *** | *** | ||||||
4.2 | Perform laboratory equipment and instrument qualification, preventive maintenance and calibration. | *** | *** | *** | ||||||
4.3 | Analyze finished Product. | *** | *** | *** | ||||||
4.4 | *** to approve shipment of finished Product to ***. *** to release Product for distribution. | *** | *** | *** | ||||||
4.5 | Review Batch Record including all pertinent documentation and data. Provide copy to *** for review. | *** | *** | *** | ||||||
4.6 | Produce Certificate of Analysis for finished Product testing. | *** | *** | *** | ||||||
4.7 | Perform stability storage and testing as requested by *** in accordance with the Manufacturing Terms. Notify *** immediately within (1) one business day, if the Product fails to meet Specifications during stability testing. | *** | *** | *** | ||||||
4.8 | Stability Testing Protocol | *** | *** | *** | ||||||
Define protocol requirements. | *** | *** | *** | |||||||
For each packaging configuration, place the *** production Batches of Product on stability and then at least one Batch annually. | *** | *** | *** | |||||||
Pull stability samples as per the approved stability protocol. Provide reviewed/approved test results to Medicis within *** of completion of testing. | *** | *** | *** | |||||||
Perform stability facility, equipment and instrument qualification, preventive maintenance and calibration. | *** | *** | *** | |||||||
4.9 | Establish approved expiration date. | *** | *** | *** |
Page 9 of 13
NO. | RESPONSIBILITIES | N/A | Medicis | AAI | ||||||
4.10 | Adverse Events and Product Complaints | |||||||||
*** shall document Product complaints and adverse event claims. *** shall notify the others key contact as specified in the Manufacturing Terms following receipt of any Adverse Event or Product Complaint. | *** | *** | *** | |||||||
*** shall promptly investigate any such complaints. *** shall provide *** with a summary of its investigation as soon as practicable, but in no event later than ***. Complaints designated by *** as high priority complaints shall be investigated by *** within ***. | *** | *** | *** | |||||||
*** shall respond to regulatory agencies and reporters and shall be responsible for all activities relating to medical surveillance. | *** | *** | *** | |||||||
Complete follow-up corrective action. | *** | *** | *** | |||||||
4.11 | Visually examine retain reference samples of finished Product annually. Investigate if required. Report all results to ***. | *** | *** | *** | ||||||
4.12 | Perform Annual Product Review. Provide copies of all information supporting annual Product reporting to ***. | *** | *** | *** | ||||||
4.13 | Prepare annual Product report and file with applicable regulatory agencies. | *** | *** | *** | ||||||
4.14 | Product Recall | *** | *** | *** | ||||||
Decide to initiate recall. | *** | *** | *** | |||||||
Notify appropriate regulatory agencies. | *** | *** | *** | |||||||
Manage recall. | *** | *** | *** | |||||||
Reconcile returned Product. | *** | *** | *** |
Page 10 of 13
NO. | RESPONSIBILITIES | N/A | Medicis | AAI | ||||||||||||
4.15 | Responsibility to Authorities | |||||||||||||||
Liaison with Regulatory Authorities for approval, maintenance and updating of drug application. | *** | *** | *** | |||||||||||||
Liaison with Regulatory Authorities for any site visits related to the Products produced for Medicis. ***to notify*** promptly within no more than one (1) business day after being contacted regarding such site visits. | *** | *** | *** | |||||||||||||
Maintain safety/hazard and handling data on Products and Active Ingredient. | *** | *** | *** | |||||||||||||
Maintain safety/hazard and handling data on Components. | *** | *** | *** | |||||||||||||
4.16 | Special test requirements (specify): | *** | *** | *** | ||||||||||||
4.17 | Maintain all Batch Records for a minimum of *** past Product expiry date and supply copies (true or electronic) of all such records to Medicis on request. | *** | *** | *** | ||||||||||||
5 | STORAGE AND TRANSPORTATION OF BULK PRODUCT, FINISHED PRODUCT AND WASTE DISPOSAL | |||||||||||||||
5.1 | Store bulk Product up to packaging. | *** | *** | *** | ||||||||||||
5.2 | Store finished Product after release by Medicis. | *** | *** | *** | ||||||||||||
5.3 | Store all materials under appropriate conditions of temperature, humidity, light and cleanliness and in a manner to avoid deterioration, theft, interference and Product contamination. | *** | *** | *** | ||||||||||||
6 | DOCUMENTATION | |||||||||||||||
6.1 | Provide *** with complete copies of Process Validation reports for the first*** Batches of each Product. | *** | *** | *** |
Page 11 of 13
NO. | RESPONSIBILITIES | N/A | Medicis | AAI | ||||||
6.2 | Provide *** with complete copies of Packaging Validation reports for each Product. | *** | *** | *** | ||||||
6.3 | Provide the following documentation to *** for each Batch: | *** | *** | *** | ||||||
Executed Batch record, including copies of labeling documenting expiration date and lot number | *** | *** | *** | |||||||
Test results for Active Ingredient and Components (upon request) | *** | *** | *** | |||||||
Manufacturing release summary: Certificate of Compliance (COC) statement indicating Product conformance with cGMP, signed by the responsible Quality individual performing Product approval | *** | *** | *** | |||||||
If Product release testing is performed by ***, testing release summary, Certificate of Analysis (COA), including: | *** | *** | *** | |||||||
- Tests performed | ||||||||||
- Test methods used | ||||||||||
- Test Specifications | ||||||||||
- Test results including retest results if required | ||||||||||
- Date of release | ||||||||||
- Signature of responsible Quality individual performing testing release |
Page 12 of 13
Medicis | AAI | |||
Quality Assurance Approval: | ||||
Name: Mark A. Prygocki, Sr. | Name: | |||
(Print/Type) | (Print/Type) | |||
Title: Chief Financial Officer | Title: | |||
Signature: | Signature: | |||
Date: | Date: | |||
AAI | ||||
Executive Approval: | ||||
Name: | ||||
(Print/Type) | ||||
Title: | ||||
Signature: | ||||
Date: | ||||
Page 13 of 13