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F,d7IIBIT C <br />CAREMARKPCS HEALTH, L.P. <br />NATIONAL ASSOCIATION OF COUNTIES <br />MANAGED PHARMACY BENEFIT SERVICES AGREEMENT <br />FOR MEMBER COUNTY <br />This Managed Pharmacy Benefit Services Agreement for Member County effective <br />is entered into by and between CaremarkPCS Health, L.P. ("Caremark") and _ <br />("Member County"). Reference is hereby made to the Managed Pharmacy Benefit Services Agreement Consumer <br />Card Program dated as of May 15, 2008 (the "Agreement") among National Association of Counties ("Customer"), <br />Member County, and Caremark under which Cusromer has engaged Caremark ro provide services ro prescription ding <br />plans for Customer and its Member Counties. <br />MEMBER COUNTY does hereby agree to be bound by, and to assume and perform, each and all of the terms, <br />covenants and conditlons of the Agreement as Member County (as defined in the Agreement) in the same manner and ro <br />the same extent as if it were a party thereto. Member County acknowledges and agrees that Cusromer and Caremark <br />may amend all or any portion of the Agreement, except with respect ro the Initial Term, and Mem~r County hereby <br />agrees to be bound by any such amendment. Customer shall give Member County reasonable notice prior ro the <br />effective date of any such amendment. If such amendment is adverse to Member County or its Participants, Member <br />County may, within ninety (90) days of receiving such notice from Cusromer, terminate its participation in the <br />Agreement by giving prior written notice ro Cusromer and Caremark. <br />Each party certifies that it shall not violate the federal aroi-kickback statute, set foih at 42 U.S.C. § 1320a-76(b) ("Anti- <br />Kickback Statute"), or the federal "Stark Law," set forth at 42 U.S.C. § 1395nn ("Stark Law"), with respect ro the <br />performance of its obligations under this Agreement. Further, Caremark shall ensure that individuals meeting the <br />definition of "Covered Persons" (as such term is defined in the Corporate Integrity Agreement between the Office of <br />Inspector General of the Department of Health and Human Services and AdvancePCS) shall coag5ly with Caremark's <br />Compliance Program, including training related ro the Anti-Kickback Statute and the Stark Law. In addition, <br />Caremark's Code of Conduct and policies and procedures on the Anti-Kickback Statute and Stark Law maybe accessed <br />at http•//www Caremark com/wos/nortaV s. l55/33707cros=CMS-2-007764. <br />Customer and Caremark, by their signatures hereto, accept and agree to Member County's participation with the <br />Agreement under the terms and conditions of the Agreement. By signing this Managed Pharmacy Benefit Services <br />Agreeaent for Member County, Member County acknowledges and agrees that the terms of the Agreement have been <br />completely read, fully understood and voluntarily accepted and further agrees ro be bound thereby. <br />NATIONAL ASSOCIATION OF COUNTIES <br />sy: <br />Title: <br />Date: <br />MEMBER COUNTY: <br />[County Name] <br />By: <br />Titles <br />Date: <br />CAREMARKPCS HEALTH, L.P. <br />By: CaremarkPCS Health Systems, LLC, its <br />General Partrer <br />By: <br />Title: <br />Date: <br />NACo k4-vl.doc (Sf2//OS) IttxClNml PaB~ I7 of 14 <br />This documrnt conmins proprietary information of Caremark, and may not lx used for any purpose othrn than to evaluate enuring loin a relationship <br />with Caremark, nor may it be duplicated mr disclosed to others for any puryose. ~.O' <br />