Fair Adantage Consortium Membership Agreement

FAIR ADANTAGE CONSORTIUM MEMBERSHIP AGREEMENT

This Agreement between Fair Advantage Consortium (FAC) at 1963 Memorial Pkwy., Ste. 5, Huntsville, AL 35801 and ______

(Practice) with an address of ______.

Practice wishes to become a member of FAC and participate in FAC’s vaccine Purchasing program, subject to the terms set forth in FAC’s vaccine agreement.

1.  Contract Term: The contract, effective ______is for automatically renewing one-year terms. FAC may terminate this agreement should Practice not comply with the provisions of the vaccine agreement upon 30 (thirty) days written notice should the practice fail to correct its noncompliance. Practice may terminate this Agreement with 30 (thirty) days written notice to FAC.

2.  Pricing: Practice shall be extended the manufacturers prices as set forth in such contracts with FAC. FAC mat receive an administrative service fee from the manufacturer(s) for its administration of the program.

3.  Practice Participation requirements: Practices that purchase pediatric vaccines will be required to purchase 80% of their pediatric vaccines from the Sanofi pediatric portfolio and 90% from the Merck pediatric profile. Practices that do not purchase pediatric vaccines, but vaccinate adolescents and adults agree to purchase from Sanofi and Merck (if applicable).

4.  It is expected that that those offices who participate in Vaccines for Children (VFC) will utilize the same vaccines for their VFC patients.

5.  Eligibility: The practice shall be notified of the effective date of affiliation by FAC. FAC shall not be held responsible should manufacturer(s) at any time decline eligibility to Practice.

6.  Confidentiality: Practice and FAC will keep the terms of this agreement confidential.

7.  FAC members will receive a 1% rebate on eligible products from the total of their FAC pediatric contract purchases annually (excluding flu products), provided the participation requirements are met (#3 above). The FAC fiscal year runs from 8/1 to 7/31. Rebates will be issued within 120 days of the end of the fiscal year.

8.  Entire Agreement: This Agreement constitutes the entire agreement between FAC and the Practice. Both parties acknowledge that any statements or documents not specifically referenced and made part of this Agreement shall not have any

effectiveness.

Fair Advantage Consortium Practice

By:______By:______

Title:______Title:______

Date:______Date:______

FAIR ADVANTAGE CONSORTIUM

Member Commitment Form

Practice Name:______

Physician Names: (please list all providers) DEA Numbers: (required)

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Practice Address: ______

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Practice Phone: ______Practice Fax: ______

Practice Contact: ______Practice Email: ______

Sanofi Acct#______Tax Id #______

Merck Acct#______(necessary for rebate)

MedimmuneAcct #______

Please Call Robin Riggs, Fair Advantage Consortium, or check out our website-Fair AdvantageConsortium.com if you have any questions.

FAC Phone number: 256-265-2464

FAC Fax number: 256-265-2467