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<br />.. <br /> <br />In addition to the site visits áuthorized by the Inspections Article of the General Provisions, <br />PERFORMING AGENCY shall allow RECEIVING AGENCY to conduct on-site quality <br />assurance reviews as deemed necessary by RECEIVING AGENCY. Unsatisfactory review <br />findings may result in implementation of General Provisions, Sanctions Article. <br /> <br />PERFORMING AGENCY certifies that neither the PERFORMING AGENCY nor any <br />individual who has a direct or indirect ownership or controlling interest of 5% or more of the <br />PERFORMING AGENCY nor any PERFORMING AGENCY officer, director, agent or <br />managing employee (e.g. general manager, business manager, administrator, director, or like <br />individual who exercises operational or managerial control over PERFORMING AGENCY or <br />who directly or indirectly conducts the day-to-day business of the PERFORMING AGENCY), is <br />an entity or individual who: <br /> <br />. Has been convicted of any offense under 42 U.S.C. § 1320a-7(b)(I)-(3); <br />.- Has had a civil monetary penalty assessed under 42 D.S.C. § 1320a and/or 42 D.S.C. § <br />1320a-8; or, <br />. Has been excluded from participation in a program under 42 D.S.C. § 1395 et seq.; or <br />under a State health care program. <br /> <br />If the foregoing statement is not true, PERFORMING AGENCY shall submit a <br />disclosure/ownership form to RECEIVING AGENCY. PERFORMING AGENCY shall <br />immediately notify the RECEIVING AGENCY in writing, in the event that the foregoing <br />statement changes during the term of this Attachment. A false statement regarding <br />PERFORMING AGENCY'S status will be treated as a material misrepresentation. <br /> <br />PHARMACY <br /> <br />If PERFORMING AGENCY is dispensing and/or providing prescribed medications, e.g., birth <br />control pills, antibiotics, etc., on site, it shall have, at a minimum, a Class D pharmacy license as <br />provIded by the Texas Pharmacy Act, Occupations Code, Chapter 560, or shall dispense and/or <br />provide such medications in compliance with other pharmacy statutes with prior approval from <br />RECEIVING AGENCY. <br /> <br />SECTION III. BUDGET: <br /> <br />PERFORMING AGENCY shall adhere to the current schedule of allowable services and rates as <br />referenced in SECTION II. SPECIAL PROVISIONS, as amended and approved by the <br />RECEIVING AGENCY. <br /> <br />Total payments will not exceed $20,000.00. <br /> <br />ATTACHMENT - Page 5 <br /> <br />T <br />