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Centers for Disease Control and Prevention (CDC)
Vaccine Management Business Improvement Project (VMBIP)

Project Points of Contact (PPOC) Users’ Guide:
Guidelines for Interactions Between
PPOCs, McKesson Specialty Distribution, and the
Centers for Disease Control and Prevention

http://www.cdc.gov/vaccines/programs/vmbip/documents.htm

TABLE OF CONTENTS

PURPOSE Page 2											

DETAILED GUIDELINES												
A.	Customer Service Page 2							 
B.	How to Ensure Provider Orders Are Received in a Timely Manner Page 4	
C.	Provider Order Delivery and Vaccine Handling Page 6
D.	Urgent (Priority) Orders and After Hours Emergencies Page 8
E.	Backorders and the Backorder Report Page 10	
F.	Inclusion of Additional Materials in Shipments Page 10
G.	Wasted or Expired Vaccine Returns	Page 10
H.	Federal Excise Tax Credits Page 11
I.	Empty Box Returns Page 11	
J.	Acts of Nature Page 12
K.	State/Local and 317-FA Funded Bulk Orders Page 12
L.	Tracking Non-Federal Vaccine Inventory Page 14
M.	Adult Vaccine Inventory Page 16
N.	Provider Order Cancellation Page 16
O.	Influenza	Page 17
P.	CDC Allocations Page 17
Q.	NCIRD Immunization Grantee Mailbox Page 17
R.	Key Messages Page 17 

CONCLUSION Page 18

PURPOSE

The purpose of this document is to provide clear guidance on the contractually defined, acceptable interactions between the grantee’s Project Point(s) of Contact (PPOC), McKesson Specialty Distribution, and the Centers for Disease Control and Prevention (CDC).  This guidance is based on Federal contracting rules and procedures, including those outlined in the Federal vaccine distribution contract and the Federal Acquisition Regulations (FAR).  If at any time the guidance in this document conflicts with the applicable Federal contracts or FAR, the contract or regulation takes precedence.  

Grantees are not party to the Federal vaccine distribution contract with McKesson Specialty Distribution and, therefore, the scope of work cannot be expanded without Federal authorization.  It may be difficult to determine if a request is within the scope of work.  Therefore, do not make requests of McKesson Specialty Distribution without consulting your Program Operations Branch (POB) project officer.  

Since grantee transitions began in February 2007, many changes have been made to the customer service guidelines and the processes the CDC and McKesson Specialty Distribution are asking grantees to adopt.  This document provides comprehensive instruction on how you, as the PPOC, should handle specific issues as they arise.  Please read this document in its entirety.  If you have any questions or suggestions, contact your POB project officer.

This guidance document does not cover guidance specific to influenza orders; for such guidance, please refer to the document entitled “Grantee Guidance for Flu Vaccine Ordering 2008-2009 Season” that was distributed as an all-grantee message on August 3, 2008.  To obtain a copy of the document, contact your POB project officer or go to the AIM members’ only website.  Due to the sensitive nature of requesting same-day rush influenza vaccine shipments, the “Grantee Guidance for Flu Vaccine Ordering 2008-2009 Season” document is not available on the VMBIP website.

DETAILED GUIDELINES

A.  Customer Service
•	All inquiries related to provider orders and shipments go to McKesson Specialty Customer Care, who can be contacted via:
o	A dedicated telephone number: 877-822-7746 (877 VAC-PRGM), and/or 
o	A group email address: cdccustomerservice@mckesson.com. 
•	Please use the toll-free telephone number or the group email address so that McKesson Specialty Customer Care can capture complete data on vaccine order issues.  
•	McKesson Specialty Customer Care acknowledges receipt of requests for assistance with shipping questions or situations within two hours.  Typical reasons you should contact McKesson Specialty Customer Care include, but are not limited to:  
o	Incorrect quantity of vaccine received; 

o	Incorrect product; 
o	Order not received by a provider; 
o	Data discrepancies between the packing list, daily shipping log, and actual product delivered; and/or 
o	Out-of-range temperature monitor reading.
•	McKesson Specialty Customer Care is available by email or phone Monday through Friday from 8 a.m. until 8 p.m. Eastern Time except for the following holidays:  Thanksgiving Day and the Friday after, Christmas Eve, Christmas Day, New Year’s Day, Memorial Day, Independence Day and Labor Day.
•	Each time you send an inquiry by email to customer service regarding a specific provider order, please include in the subject heading the provider’s PIN and name as they appear in VACMAN and your telephone number so that McKesson Specialty Customer Care can acknowledge your email via telephone.
•	Each inquiry is assigned to a McKesson Specialty customer service representative.  This representative “owns” the inquiry and follows up on your behalf with other individuals as necessary until the issue is resolved.  Therefore, please do not contact individual McKesson Specialty customer service representatives, CDC, or the McKesson Specialty Distribution warehouse staff about an inquiry, as this may result in duplication of effort and a delay in resolving the issue.  In the event you have reported an issue to McKesson Specialty Customer Care and have not received a response within a reasonable* amount of time, please refer to the escalation chart in the VMBIP web site at http://www.cdc.gov/vaccines/programs/vmbip/documents.htm to get the issue resolved.  *A reasonable amount of time depends on the situation.  Please use your judgment on how long to wait before escalating an issue based upon the type of issue and the time sensitivity.  
•	Do not copy the vaccinedistributionc@cdc.gov mailbox on customer service issues.  Use this email box only to:
o	Request that grantee-specific flyers be included in the vaccine shipments to providers (see Section F); 
o	Send the “State and 317-FA Funded Bulk Order” Excel spreadsheet (see Section K); 
o	Provide advanced notice of plans to place large provider orders of adult vaccines (see Section M); and 
o	Ask questions about cancellation reports (see Section N).
•	McKesson Specialty Distribution has two regional account manager positions to assist you and the POB project officers.  To locate the name and email address of your regional account manager, please refer to the account manager by state document on the VMBIP web site at http://www.cdc.gov/vaccines/programs/vmbip/documents.htm.  The roles of the regional account managers are as follows: 
o	Decrease response time for emergency situations;
o	Increase customer satisfaction;
o	Coordinate service support and service communications;

o	Coordinate calls with PPOCs and McKesson Specialty Distribution operations;
o	Participation in face-to-face meetings with you;
o	Ensure ongoing communication with customer care manager, team lead, McKesson Specialty Distribution management team, POB project officers, and you; and
o	Proactively manage grantee issues. 

B.  How to Ensure Provider Orders Are Received in a Timely Manner  
•	McKesson Specialty Distribution downloads provider orders daily through the Secure Data Network (SDN).
•	Your first step is to conduct a daily check of provider orders to ensure they have been transmitted accurately through VACMAN.  You can review pending orders in VACMAN by looking at the “Orders Entered, Not Yet Sent to CDC” and “Orders Sent to CDC, Not Yet Shipped” reports.
•	Immediately after you transmit, you should see “Pending CDC Approval” on your submitted provider orders until the next time you download from CDC.  Then, the order status should change to one of the following:
o	Submitted to Manufacturer.  This indicates that there were no errors and the provider orders were sent to McKesson Specialty Distribution; 
o	Held at CDC; or 
o	Cancelled. 
•	Reasons orders may be held at CDC or McKesson Specialty Distribution: 
o	NIPVAC (the CDC software that tracks vaccine target balances) notifies the CDC Resource Allocation and Monitoring (RA&M) team when your NIPVAC balance is down to 25 percent of the quarterly target.  If this occurs, your RA&M monitor contacts you to discuss possibly updating your Vaccine Ordering Forecast Application (VOFA).  If you exhaust your target budget, orders are held at CDC due to lack of funds in your account. 
o	Orders may be held by CDC because the vaccine selection was disabled or the contract is expired. 
o	Orders may be held by McKesson Specialty Distribution for the following reasons:
•	Vaccine ordered in a quantity that cannot be filled, such as a single dose      ordered from a multi-dose vial;
•	Vaccine temporarily out of stock; 
•	Restricted days and hours of operation at the provider site;
•	You exceed your allocation in shortage situations;
•	Federal holiday;
•	You request non-shipment to all providers for a specific period of time;
•	You request non-shipments to specific providers temporarily due to inclement weather or other natural disasters;
•	IT related issues at McKesson Specialty Distribution; and 

•	Contractual language to ship certain days of the week. 
•	If you continue to see “Pending CDC Approval” in VACMAN one business day after transmitting the order, please contact your RA&M monitor as there may be funding implications.  For example, on Monday you key the order and transmit.  If on the Tuesday after you transmit, you still see “Pending CDC Approval,” contact your RA&M monitor.   
•	Please remember to download periodically from CDC, even when you are not placing an order, to ensure you have the latest VACMAN status updates. 
•	Two auto-generated reports are available to you from CDC via daily email:
o	Order Processing Notification 
•	This email is generated from NIPVAC for every grantee order package   processed by CDC.  The email summarizes the orders received in the package by category:  Bulk Orders, Direct Ship orders, and Provider orders.  An Excel file is generated and included in the email to explain why any provider orders contained in the package could not be processed.  An Excel file is generated when any of the following errors occurs:
•	Provider orders “Rejected by CDC.”   Reasons include:  Invalid NDC, Duplicate or Invalid Order ID, or corrupt order data. 
•	Provider orders “Held at CDC.” Reasons include:  held for funding or provider data (address, city, state, etc.) missing or invalid.
o	Missing Orders Notification
•	This email is generated from NIPVAC to inform you when there is a gap in the sequence of orders CDC received.  In other words, CDC is missing one or more order.  The email outlines the number of orders missing, the date range, and the possible package within which the orders should be contained. 
•	A feature in VACMAN 4.1.4.2 validates the order information as well as the provider data during the transmit process.  If an order is rejected during the transmit process, VACMAN creates two spreadsheets:
o	ProviderError<YYYYMMDDHHSS>.xls; and 
o	ProviderRej<YYYYMMDDHHSS>.xls. 
            If this occurs:
o	Open the ProviderError<YYYYMMDDHHSS>.xls spreadsheet to view the reason(s) the order was rejected.  On the ProviderRej<YYYYMMDDHHSS>.xls spreadsheet, make the necessary corrections to the rejected order(s), and ensure the Order Date field is populated with the current date in the format MM/DD/YYYY (enter format as shown to include “/”); 
o	Use the ProviderRej<YYYYMMDDHHSS>.xls file as the import file to reload the orders into the VACMAN new orders table;
o	Run the report “Orders Entered, Not Yet Sent to CDC” to confirm that the corrected orders are in the file; and

o	Transmit the orders to CDC.
•	Contact McKesson Specialty Customer Care if you have questions about a provider order status if the order status in VACMAN reads anything other than “Held at CDC” or “Pending CDC Approval” more than one business day after transmitting.
•	If McKesson Specialty Distribution has not received the order, please verify that the order was keyed and transmitted correctly through VACMAN.  
o	If the order has not been keyed, enter it and make sure it transmits through VACMAN.  
o	If it was keyed and did not transmit, contact the VACMAN Help Desk at 404-639-8303 or vacman@cdc.gov for further assistance. 
•	It is your responsibility to ensure that providers’ hours of operation and addresses are correct in VACMAN.  A significant number of the shipments returned to McKesson Specialty Distribution are due to incorrect provider address and/or open days/hours listed in VACMAN.  Please double check the accuracy of the addresses and shipping instructions each time you enter a provider order.  
•	McKesson Specialty Distribution typically ships Mondays, Tuesdays, and Wednesdays.  Providers generally do not receive shipments on Fridays and Mondays. McKesson Specialty Distribution ensures that providers do not receive shipments on Federal holidays.  To ensure that shipments do not arrive on additional days surrounding certain other holidays when your provider offices may be closed, McKesson Specialty Distribution needs to know the specific dates that all providers in your jurisdiction should NOT RECEIVE shipments surrounding the specific holiday.  CDC sends an email to you prior to each of these holidays (Independence Day, Thanksgiving, and Christmas/New Years) asking if you want to pause shipments temporarily during the time surrounding these holidays.  The email instructs you to list the dates surrounding the particular holiday that you do not want shipments to arrive.  Send your request to cdccustomerservice@mckesson.com.   If you request to pause shipments temporarily, this information overrides all your providers’ open days and hours in VACMAN only for the dates you list.  It is very important that you stop transmitting orders in VACMAN at least one calendar week prior to the dates you list in order to reduce the number of orders being held at McKesson Specialty Distribution.  For example, if you do not want any of your providers to receive shipments from December 17 through January 5, do not submit orders after December 10.
•	In the event an individual provider’s office is closed for an extended period of time (e.g., a holiday week or staff vacation), please do not place an order until the provider returns and can accept delivery.  McKesson Specialty Customer Care should not be asked to hold orders for an individual practice due to planned office closures.  
•	You are permitted to contact McKesson Specialty Customer Care to request grantee-wide hold on all orders for times when you are affected by acts of nature and do not want shipments delivered.  See Section J for details.

•	If a provider’s shipping instructions show open days on Mondays and Fridays, ensure the provider is aware that a delivery could occur on those days.  When you enter the shipping instructions into VACMAN and do not indicate any hours (after you select the days of the week), the carrier may deliver anytime between 9 a.m. and 5 p.m.  If the provider site is open from 9 a.m. to 5 p.m. but closed from 12 p.m. to 1 p.m. for lunch, you must not leave the hours as a blank.  In this case, you must insert “9 TO 12 AND 1 TO 5” after the days of the week. 

C.  Provider Order Delivery and Vaccine Handling
	Provider Order Delivery
•	If the carrier attempts deliveries when the shipping instructions indicate that the provider site is open, but at delivery the provider site is closed, McKesson Specialty Distribution intercepts the shipment at the 48th hour and has it rerouted back to the warehouse in an attempt to save the vaccine.  If the temperature monitor has not tripped, the vaccine is returned to operating inventory.  Within two business days of the failed delivery, McKesson Specialty Customer Care contacts you by phone or email to notify you of the reason for the delay and coordinate a re-shipment.  Therefore, do NOT key a new order into VACMAN for that failed shipment. 
•	In the event a provider refuses to accept the vaccine shipment, the carrier documents the date, time, and intended recipient of the package and returns the vaccine shipment to McKesson Specialty Distribution. Within two business days of the failed delivery, McKesson Specialty Customer Care contacts you by phone or email regarding the provider’s refusal of the vaccine shipment and coordinates a re-shipment if appropriate.  Therefore, do NOT key a new order into VACMAN for that failed shipment.  Please contact your provider to determine why the shipment was rejected.  Use this opportunity to educate the provider on appropriate topics such as what the box looks like, when to place an order, when to expect delivery of an order, and notification of an address or shipping instruction change.  Advise the provider that a re-shipment is being shipped.
•	If a provider has received shipment and the order status in VACMAN does not change by the 3rd business day, contact the VACMAN Help Desk.  
•	McKesson Specialty Distribution is aware that in some instances providers have found vaccine packages left on their doorstep.  When providers have a FedEx signature release on file, it allows FedEx to drop off any FedEx package without a signature.  CDC and McKesson Specialty Distribution cannot override the signature release on file for vaccine shipments.  You may want to consider recommending that your providers cancel their signature release on file; however, such a cancellation applies to all packages (vaccine and otherwise).

Vaccine Handling, Compromised Vaccine, Temperature Monitor Issues, and Split Shipments

•	Providers must open vaccine packages immediately, check the temperature monitor reading, inspect the vaccine, compare the vaccine and the packing list, and store at appropriate temperatures.  If vaccines have been compromised or if temperature monitors are out-of-range, not present in the box, or a warm indicator is not activated, please notify McKesson Specialty Customer Care immediately.  According to the language in the centralized vaccine distribution contract, CDC is financially liable for replacing compromised vaccine that is not reported to McKesson Specialty Customer Care within two hours of the provider signing the receipt, even if the cause of the problem was not due to provider or your error.  Please ensure your providers understand this instruction and encourage them to notify you immediately in the event a vaccine shipment is compromised. 
o	If the vaccine is determined to be nonviable, you must contact McKesson Specialty Customer Care to arrange pick up of the product and temperature monitor for return to McKesson Specialty Distribution within two business days. Failure to return vaccine in a timely fashion could be construed as fraud in the Vaccines for Children (VFC) Program.  McKesson Specialty Distribution ships a replacement order to the provider.    
•	In general, viable vaccine is not returned to McKesson Specialty Distribution’s Federal operating inventory.  Therefore, if one of your providers receives an over-shipment of vaccine and is unable to store or use it prior to product expiration, other providers within your jurisdiction should be sought who can utilize the extra doses.  However, if you are not able to arrange for redistribution of these vaccines to local providers, you may call McKesson Specialty Customer Care to request that the over-shipped doses be returned to McKesson Specialty Distribution.    
o	If the cause of the over-shipment was your error (such as entering the wrong number of doses into VACMAN), McKesson Specialty Distribution consults with CDC, and CDC works with you directly on a case-by-case basis to assess cold chain integrity and determine if the doses can be returned to McKesson Specialty Distribution’s Federal operating inventory.  If CDC determines that the doses can be returned to Federal operating inventory, your account is credited accordingly.     
o	If the cause of the over-shipment was due to McKesson Specialty Distribution error, McKesson Specialty Customer Care works with you to gather information and then contacts CDC to determine next steps.
•	Encourage your providers to contact you if they receive a split or partial shipment. Please see examples of split and partial shipments below.
o	Split shipment – A provider orders 50 doses.  Twenty doses arrive in the first box.  The packing slip shows 30 more doses should be in the second box.  However, the second box does not arrive with the first box.  A split shipment occurs regardless if the second box arrives later on the same day or on any other day.

o	Partial shipment – A provider orders 50 doses.  The packing slip shows that all 50 doses are supposed to be in the same box.  However, only 20 doses are in the box. 
Please notify McKesson Specialty Customer Care every time a provider receives a split or partial shipment.  McKesson Specialty Customer Care logs each case into its database, Sales Tool for Optimal Relationship Management (STORM), and uses the STORM data to do root cause analysis.  The analysis is used to make improvements in the picking and packing at the warehouse and to reduce the frequency of carrier split shipments.  McKesson Specialty Customer Care corrects the error or tracks the status of the remainder of the order and gives you the information you need to share with your provider.   
•	For shipments containing MMR vaccine, please ensure that your providers count the number of diluent doses as soon as MMR shipments arrive at the clinic site to verify the correct match of vaccine doses to diluent doses.  If there is a shortage of diluent doses for the number of MMR doses shipped, have the providers notify you immediately so you can contact McKesson Specialty Customer Care.  Merck ships Varicella with the diluent packed in the top compartment of the shipping container, so please ensure that the providers remove the diluent from the top compartment of the shipping container prior to discarding/recycling the shipping container.  If there is a shortage of diluent doses for the number of Varicella doses shipped by Merck, please promptly contact Merck directly. 

D.	Urgent (Priority) Orders and After Hours Emergencies
Urgent (Priority) Orders
•	For urgent (priority) shipments, McKesson Specialty Distribution places these orders ahead of routine orders for fulfillment and ships the same day as received, using expedited delivery (overnight).  When special arrangements are requested by a provider through you, McKesson Specialty Customer Care works with you to arrange for receipt of the shipment on a Friday or Saturday (with your prior approval) if the provider is available to receive the shipment.
•	The first step in placing a priority order is to check the “Urgent Order” box in VACMAN.  Failure to do so makes the order difficult to track, bill and ship.  CDC pays a higher rate for urgent (priority) orders, so please use this option only in the case of a true emergency.  In general, if you order multiple vaccines for a provider but select the “Urgent Order” box on only one or some of the vaccines, the vaccine(s) with the “Urgent Order” box checked ships separately from the other vaccines.
•	After you have transmitted an urgent (priority) order, call or email McKesson Specialty Customer Care to ensure that the order is, indeed, being treated as priority.
•	
In the event of a public health emergency or if a provider needs vaccine sooner than the 24-hour VACMAN-to-McKesson Specialty Distribution transmission time allows, follow these steps:
o	Put the order in VACMAN as an urgent (priority) order and email screen shots of the order to McKesson Specialty Customer Care, your POB project officer, and your RA&M monitor immediately, who facilitate an expedited approval.  Acceptable screen shots indicating the specific NDC(s) requested are “Provider Receipts” or “Provider Orders;”
o	In the email, include the provider’s address and open days/hours in the body of the email or attach a screen shot of the “Order Entry” (Multi-Order) screen or “Order History” (Multi-Order) screen;
o	Transmit at your usual time; and
o	Follow up with a phone call to McKesson Specialty Customer Care that you just sent screen shots by email.  Sending in screen shots is not required if you do not need the vaccine shipped the same day.   
•	If the provider who is responding to the public health emergency needs only a minimal quantity of doses immediately, please:
o	Try to borrow those doses from a nearby clinic;
o	If successful in borrowing doses, place an order in VACMAN to replenish the doses borrowed from the donor clinic; and
o	Place a separate order in VACMAN using the urgent (priority) order feature (without submitting screen shots of the order) for the remainder of the doses needed, for shipment the next business day to the site responding to the public health emergency.
•	Examples of situations where an urgent (priority) order is appropriate include but are not limited to: disease outbreaks, flooding, and other natural disasters.  
•	Except for IT glitches or other issues beyond your control (discovered long after you placed the order in VACMAN) that would have caused a delay in a regular shipment, it is inappropriate to request that McKesson Specialty Customer Care expedite an order without first selecting the “Urgent Order” box in VACMAN.

After Hours Emergency Ordering Procedure
Please refer to the all-grantee message dated August 29, 2008, for guidance on how to request an after hours rush order for same-day shipment.  Due to the sensitive nature of requesting an after hours rush vaccine shipment, such guidance is not available on the VMBIP website.  To obtain a copy of the all-grantee message, contact your POB project officer or go to the AIM members’ only website.

E.  Backorders and the Backorder Report
•	A backorder report is auto-generated by McKesson Specialty Distribution and emailed directly to you each day.  This backorder report is sent at the same time as the auto-generated shipping log but is sent as a separate email.  Unlike the shipping log which is emailed only on days in which vaccines are shipped, the backorder report is emailed every day (Tuesday morning through Saturday morning) covering the previous day’s data.  On days in which there are no orders on backorder, the file is empty.  The report is cumulative, so when a vaccine appears on the report, it remains on the report every day until the vaccine is shipped or until the order is cancelled. 
•	Backordered vaccines do NOT appear on the packing list included in the vaccine shipments sent to your providers. 
•	The backorder report captures a vaccine when:
o	There is insufficient inventory to fill that vaccine order at the distribution center that services your jurisdiction; or
o	You order in excess of an allocated vaccine even though there actually are doses in inventory at the distribution center that services your jurisdiction.    
•	If you have any questions about this report, contact McKesson Specialty Customer Care.  You may need to reference certain information on the report, such as the Sales Order Number, Delivery Doc Number, and the Plant Number, in order for the customer service representative to answer your question. 
•	In the event a vaccine is out of stock at the manufacturer, CDC sends an email to all grantees notifying you that the item is not available.  The corresponding NDC is removed from VACMAN so orders for this product cannot be placed.  

F.  Inclusion of Additional Materials in Shipments
•	If you want to include materials in vaccine shipments, send a request to CDC containing the electronic version of the document(s), the timeframe you want McKesson Specialty Distribution to include the materials in the shipments, and a contact phone number to vaccinedistributionc@cdc.gov (.PDF format is preferred). 
•	CDC provides an initial response to your request within three business days.
•	CDC may limit the number and size of such materials.  There is no contractual requirement for McKesson Specialty Distribution to print these inclusions; therefore, after receipt of CDC approval, you must print and ship a supply of materials directly to the distribution center that services your jurisdiction.  CDC notifies McKesson Specialty Distribution of approved materials to include in vaccine shipments.  McKesson Specialty Distribution will not ship additional materials without CDC approval.
•	Vaccine Information Statements (VIS) are not approved materials to include in vaccine shipments.  

G.  Wasted or Expired Vaccine Returns
•	McKesson Specialty Distribution accepts the return of all nonviable (e.g., wasted or expired) vaccine from providers, which also includes influenza vaccine and direct-ship vaccines, and arranges for return of nonviable vaccine to McKesson Specialty Distribution at no cost to the provider.  
•	You and McKesson Specialty Distribution do NOT need to be involved in returning wasted/expired vaccine if the carrier arrives to deliver another package (vaccine or otherwise) and all the following conditions are met: 
o	The driver has room in the truck; AND 
o	You have procedures in place to ensure that the provider submits a copy of the grantee-specific wastage form to you; AND 
o	You have procedures in place to ensure that the provider has included a copy of the grantee-specific wastage form in the box containing the vaccine.
If there is no room in the truck, you must contact McKesson Specialty Customer Care to request a separate trip to pick up the expired/wasted vaccine at the provider site.  
•	You and McKesson Specialty Customer Care MUST be involved when a provider proactively requests pick-up service of wasted/expired vaccine that requires a special trip by the carrier.  The provider must contact you, and then you must contact McKesson Specialty Customer Care to coordinate the pick-up service.  Providers may NOT contact McKesson Specialty Customer Care to coordinate pick up of wasted/expired vaccine.  Coordinating pick up for wasted/expired vaccine must go through you.  
•	Remind providers to: 
o	Include a copy of the wasted/expired vaccine form in the returns box;
o	Send a copy to you; and
o	Keep a copy for their records.
•	Remind providers NEVER to include pre-drawn syringes, open/empty syringes, and open/empty vials in the returns box
•	If you fail to contact McKesson Specialty Customer Care and the package arrives at the distribution center with no wasted/expired form, it is very difficult to reconcile the provider’s return.  Please be sure to follow the steps exactly each time a provider has wasted or expired vaccine to return.
•	If you have any questions about the returns process, please contact your POB project officer.

H.	Federal Excise Tax Credits
This section incorporates how McKesson Specialty Distribution handles nonviable vaccines that are returned by providers as well as vaccines that expire while still on the shelves at McKesson Specialty Distribution, including both Federally contracted vaccines and non-Federally contracted, grantee-specific (virtual inventory) vaccines.  We are working on an excise tax credit procedure and intend to update this document at that time.  

I.	Empty Box Returns
•	It is highly recommended that providers return the empty shipment boxes.  Included on the inside flap of each shipped box is an affixed return label along with enclosed instructions for returning the shipping container.
•	In the rare event your provider’s box does not have a return label affixed to the inner flap of the box, the provider may call McKesson Specialty Customer Care directly to obtain a return label or instructions regarding return of the box. 
•	You and McKesson Specialty Distribution do NOT need to be involved in returning empty boxes if the carrier arrives to deliver another package (vaccine or otherwise) and  the driver has space in the truck to accept the empty box.  If there is no room in the truck, you or your provider must contact McKesson Specialty Customer Care to request a separate pick-up service of the empty box.
•	McKesson Specialty Customer Care MUST be involved when you or a provider proactively requests pick-up service of empty boxes that requires a special trip by the carrier.  In this case, the provider may call McKesson Specialty Customer Care directly to coordinate pick-up service. Alternatively, the provider may contact you, and then you would contact McKesson Specialty Customer Care to coordinate the pick-up service.
•	Requesting empty box pick-up service is the only time it is appropriate for the provider to have direct contact with McKesson Specialty Customer Care.
•	McKesson Specialty Customer Care currently works primarily with UPS to collect all returned boxes.  Neither you nor your providers should contact UPS or other carriers.  Doing so may result in your providers being charged for the pick up.  

J.  Acts of Nature (e.g., Flood, Hurricane, Snow and Ice Storm, and Wildfire)
•	McKesson Specialty Distribution does not monitor the weather for shipping conditions in your jurisdiction, and continues to fill and ship orders to providers unless a request is made by you directly to McKesson Specialty Customer Care.  
•	In order to pause shipments temporarily to providers in affected areas: 
o	Call McKesson Specialty Customer Care; 
o	Send an email as soon as possible to McKesson Specialty Customer Care at cdccustomerservice@mckesson.com; 
o	Send an email as soon as possible to your regional account manager.  To locate the name and email address of your regional account manager, please refer to the account manager by state document on the VMBIP web site at http://www.cdc.gov/vaccines/programs/vmbip/documents.htm.  
o	Follow up with an email and/or telephone call to your POB project officer and your RA&M monitor, as this may have funding implications.
•	If a shipment is en route and cannot be suspended, contact the provider(s) to determine if someone is available to receive the shipment.  If the provider(s) is (are) not available to receive the shipment, please contact McKesson Specialty Customer Care and your regional account manager to request that McKesson Specialty Customer Care recall the shipment(s).

•	McKesson Specialty Distribution recognizes that there may be very rare situations when they can not intercept a shipment before it gets delivered; however, they are committed to doing everything possible to avoid these situations.   
•	Please follow up with McKesson Specialty Customer Care and your regional account manager to secure a second delivery attempt once affected areas are clear.

K.  State/Local and 317-FA Funded Bulk Orders 
McKesson Specialty Distribution receives and ships the following vaccines to providers, in addition to the standard Federally contracted vaccine inventory:	 
•	Non-Federal vaccines and biologicals, which include those vaccine presentations (i.e., NDCs) that are not available on the CDC Federal contract;
•	Federal vaccines purchased with state/local dollars using the Federal contract; and
•	Vaccine presentations that are available on the CDC Federal contract, but are purchased with state/local dollars using a non-Federal contract.
In order to ensure proper management of this inventory, McKesson Specialty Distribution needs to receive information from you detailing incoming purchases.  The following process outlines the necessary steps to inform McKesson Specialty Distribution that you placed a state/local funded bulk order with a manufacturer.  You are required to complete and submit the “State and 317-FA Funded Bulk Order” Excel spreadsheet according to the instructions every time you place an order for state/local and 317-FA funded bulk orders, including bulk orders you place through CDC Federal vaccine contracts as well as bulk orders you place outside CDC Federal vaccine contracts.  Do not include direct-ship vaccines, rabies, or smallpox vaccine on this spreadsheet, because McKesson Specialty Distribution does not store or ship these vaccines.  Failure to follow this procedure results in delayed receipt of vaccine shipments at McKesson Specialty Distribution and, therefore, delayed notification to you.  It is also critical to comply with your state/local funded replenishment schedule because CDC relies on your scheduled replenishment orders to plan and monitor the overall Federal operating inventory levels.
  
Step 1 - Order Placement
1.	Please follow your normal processes for placing bulk orders both within VACMAN and outside of VACMAN.  For vaccines purchased outside of VACMAN, please inform the manufacturers to ship the product to your assigned centralized distributor center.  Please refer to the most current “State and 317-FA Funded Bulk Order” Excel spreadsheet to obtain the address and shipping contact information for each distribution center. 
Step 2 - Communication to McKesson Specialty Distribution
1.	As mentioned above, you must fill out the “State and 317-FA Funded Bulk Order” Excel spreadsheet detailing orders by NDC every time an order for a state/local and/or 317-FA funded bulk order is placed.  Please:
a.	Insert the grantee initials or full spelling at the top of the spreadsheet;

b.	Provide the name, telephone number, and email address of the appropriate contact person for the grantee;
c.	Provide the date of the order; and
d.	Complete a separate line in the table for each NDC ordered.  
2.	Save the form as “State and 317-FA Funded Bulk Order for [Grantee Initials] [Date]” and email it to:
  	      a.	Your POB project officer;
	      b.	vaccinedistributionc@cdc.gov; and 
	      c.	cdc@mckesson.com.
3.   Include the form name “State and 317-FA Funded Bulk Order for [Grantee Initials] [Date]” in the subject line of the email.	 

McKesson Specialty Customer Care emails you a scanned copy of the manufacturer packing slip including the signature and date the vaccine was received at McKesson Specialty Distribution’s warehouse.  If you have a question about the status of receipt notification, contact McKesson Specialty Customer Care, not the warehouse. 

You must submit the “State and 317-FA Funded Bulk Order” Excel spreadsheet for tracking purposes at CDC and McKesson Specialty Distribution.  Completing this form with the Federal purchase order (PO) (if applicable) and the state/local PO greatly assists McKesson Specialty Distribution in matching the manufacturers’ packing list to grantee bulk orders.  You do not receive the “State and 317-FA Funded Bulk Order” Excel spreadsheet back from McKesson Specialty Customer Care because the scanned manufacturer packing list from McKesson Specialty Distribution is sent and serves as a more complete record.  

L.  Tracking Non-Federal Vaccine Inventory 
You must monitor your grantee specific non-Federal vaccine inventory and product expiration dates to determine when to reorder, and to ensure accuracy, accountability, and availability.  Monitoring the expiration dates helps to ensure that your providers receive vaccine with acceptable expiration dates.  Vaccine and biologicals purchased with state/local and/or 317-FA funds that do not exist on the Federal contract are stored as grantee-specific “virtual inventory” at McKesson Specialty Distribution warehouses.  These products are physically segregated in grantee-specific bins.  There are four steps to successfully track and monitor your virtual inventory.  
1.	Using the data warehouse-generated Grantee-Specific Inventory Report and your historical distribution data, establish a beginning physical inventory.  Immediately after the physical inventory is established, track transactions including doses ordered, new purchases, and transfers to/from other grantees, etc.

2.	Once a beginning inventory is established, estimate how long this inventory will last based on estimated provider usage. Using the reports in VACMAN entitled “Orders Sent to CDC, Not Yet Shipped” and “Orders Shipped,” review historic usage for the same time period last year, or review data in your spend plan.  Keep in mind that past and future vaccine usage per month is influenced by several factors including seasonality, availability of product, short or long expiration dates, allowing or disallowing provider vaccine choice, arrival or departure of products including combination vaccines, etc.  
3.	Knowing historic usage assists you with establishing reorder thresholds.  When establishing a reorder threshold, also keep in mind the length of time it takes for vaccine to be ordered and shipped and receipt of delivery notification from McKesson Specialty Distribution. 
4.	Knowing the number of weeks/months of inventory helps you determine how often to monitor inventory levels, which is the fourth and final step.  For example, if a six week inventory level is kept for a specific non-Federal vaccine, you may decide to monitor usage weekly after establishing a beginning inventory until the reorder threshold is met.  Once the inventory on hand is at or near the threshold, reorder vaccine and monitor the inventory as needed to ensure that orders placed against the specific non-Federal vaccine do not exceed the inventory.  After you transmit to CDC, use the reports in VACMAN entitled “Orders Sent to CDC, Not Yet Shipped” and “Orders Shipped” to determine current usage and record your data.  Consider using an Excel spreadsheet like the example below.  

Below is the data from a chart.  It is arranged by Date, Beginning Inventory, Doses Ordered, Doses Received, Ending Balance, Threshold Amount, and  Actions Needed and Comments if there are any.

9/1/2008
300
80
0
220
100

9/7/2008
220
40
0
180
100

9/14/2008
180
40
0
140
100

9/21/2008
140
50
0
90
100
Reorder Now

9/28/2008
90
20
0
70
100

10/5/2008
70
50
300
320
100

10/12/2008
320
50
0
270
100

Virtual Inventory Transfer Process
•	In an effort to prevent wastage, we encourage you to transfer doses from your virtual inventory into another grantee’s virtual inventory if you think that you will not be able to use the vaccine before it expires. This may occur only when the two grantees are serviced by the same distribution center.  
•	To transfer virtual inventory to another grantee, send an email to your POB project officer with the following information: 
o	Your name and jurisdiction’s name;
o	Your contact information;
o	Distribution center that services your jurisdiction;
o	Description of virtual inventory you would like to donate/trade to another  grantee, including:
•	Name of product(s);
•	Manufacturer(s);
•	NDC(s);
•	Number of doses; and 
•	Expiration date(s).
•	Your POB project officer posts your solicitation to the all-grantee mailbox.
•	Recipient grantee contacts you directly to arrange specifics. 
•	Send an email with the subject heading "Request to transfer virtual inventory doses to another grantee" to cdccustomerservice@mckesson.com and copy the recipient grantee stating: "Please transfer _X_ doses of NDC _Y_ with the expiration date of ABC from my virtual inventory into the virtual inventory of Grantee _Z_.”   
•	McKesson Specialty Customer Care replies to both the donor and recipient grantees when the transfer is complete so that the recipient grantee knows when it is possible to place individual provider orders for the product(s).  
•	Changes to the donor and recipient grantees’ virtual inventory appear on the Grantee-Specific Inventory Report. 
•	Please note that doses of PPV23 for use in high-risk children must be purchased outside the Federal contract using state/local and/or 317-FA funds.  Although this vaccine is intended to be part of your virtual inventory, it is not stored as virtual inventory because the NDC exists on Federal contract.  Therefore, these doses are not included on your Grantee-Specific Inventory Report.  Because PPV23 is part of the Federal operating inventory, it is not necessary for you to monitor the expiration dates because first-expired-first-out policy is observed on Federally contracted vaccines.
DT and Td (DECAVAC) Vaccine Orders
VACMAN gives you the ability to allow your providers to order single doses of DT as well as pediatric Td (DECAVAC), instead of ten doses as the minimum order size.

M.  Adult Vaccine Inventory
For adult vaccines, the policy is that CDC maintains a level inventory.  Because adult vaccines have an unpredictable demand, there is a tendency for these vaccines to sit for a long time at McKesson Specialty Distribution as well as an even longer time at the provider’s office.  The reason for this policy is that CDC’s old replenishment model put more inventory at McKesson Specialty Distribution to account for unanticipated large orders which put all the risk of expiration and subsequent loss of dollars on CDC.  This risk is better left at the manufacturers where it is most efficiently managed.

Due to the inherent difficulty in determining the appropriate inventory to store at McKesson Specialty Distribution to ensure adequate supply of adult vaccines from week to week, CDC can be faced with some expired adult vaccines, or vaccine sent to your providers may have a short expiration date.  Because the spend plans describe monthly purchase plans and do not contain NDC numbers, the spend plans do not contain enough information to ensure sufficient inventory to fill orders.  To help minimize vaccine loss and to ensure sufficient inventory to fill orders for adult vaccines, please do the following:

If the sum of your entire project's orders for a particular product is anticipated to be in excess of 3,000 doses in a month and if a monthly order volume of this size for this particular product is unusual for your project area, please contact CDC as soon as possible by sending the following information to vaccinedistributionc@cdc.gov and cc your POB project officer: 
•	Brand;  
•	Presentation (NDC); and
•	Number of doses. 

This communication gives CDC enough time to ensure adequate inventory at McKesson Specialty Distribution for large adult vaccine orders, and through your own planning processes, allows you to know about large monthly orders somewhat in advance of placing them. 

N.  Provider Order Cancellation
If you notice an error in a provider order in VACMAN, please correct it before transmitting.  It is important to verify the accuracy of each provider order before you transmit because cancelling an order is a time-consuming, manual process for both CDC and McKesson Specialty Customer Care.  If you still need to cancel an order, contact McKesson Specialty Customer Care immediately via telephone and email.  Please be aware that cancellations may be requested but are not guaranteed.  If the cancellation occurs before the order is shipped, then your account is automatically adjusted for the value of the cancelled order. 

O.  Influenza
In order to expedite the delivery of influenza vaccine, McKesson Specialty Distribution established and is maintaining an influenza-only vaccine distribution line.  As a result, influenza vaccine arrives in separate boxes from other vaccines even if those orders are placed at the same time in VACMAN.  Please notify your providers of this procedure.  

As mentioned in the Purpose section, this document does not cover other guidance specific to influenza orders; for such guidance, please refer to the document entitled “Grantee Guidance for Flu Vaccine Ordering 2008-2009 Season” that was distributed as an all-grantee message on August 3, 2008.  To obtain a copy of the document, contact your POB project officer or go to the AIM members’ only website.  Due to the sensitive nature of requesting same-day rush influenza vaccine shipments, the “Grantee Guidance for Flu Vaccine Ordering 2008-2009 Season” document is not available on the VMBIP website.

P.  CDC Allocations
In the event of a national vaccine shortage, CDC implements an allocation process, and the Vaccine Supply and Assurance Branch allocates doses to each grantee.  In addition, CDC is testing an allocation functionality in NIPVAC for influenza vaccine distribution that may also be used during national shortages in the future.  

McKesson Specialty Distribution utilizes an allocation system as well.  Any allocated product that you order in excess of your allocation is placed in backorder status and therefore appears on your daily backorder report, even if there are doses in inventory at the distribution center that services your jurisdiction.

Each of these systems can assist you with keeping track of your vaccine allocations and prevent orders over your allocations.  It is your responsibility to monitor the doses allocated and not order beyond your allocation.  

Q.  NCIRD Immunization Grantee Mailbox 
VMBIP information and updates are currently distributed to grantees through the NCIRD Immunization Grantee Mailbox.  There may be key VMBIP personnel at the grantee level who are not receiving these messages.  If you have staff that should be added to the distribution list, please provide your POB project officer with a list of email addresses that you would like added to the distribution list for VMBIP messages.  This list should include only those persons who are not currently receiving messages through the NCIRD Immunization Grantee Mailbox and who should be included on messages related to VMBIP.  

R.  Key Messages
Please be mindful of the following key messages and communicate them to your providers:
•	Description of the boxes used by McKesson Specialty Distribution so providers are aware and do not refuse to accept shipments;

•	How to interpret chemical monitors, and that there are both a warm indicator and a cold indicator in every box year-round;
•	Acronyms on written materials.  The acronym “PPOC” appears in the chemical monitors flyers that are included in the shipments.  Ensure that your providers understand that the PPOC is you;
•	McKesson Specialty Distribution uses primarily FedEx for shipping;
•	McKesson Specialty Distribution uses only UPS for pick up except in rare circumstances in which there is a problem with UPS service;
•	Expectation setting.  There is a two-to-three week delivery time.  Instruct providers to submit orders to you to allow for enough lead time;
•	Expect vaccine deliveries on Monday and Friday if the provider shipping instructions in VACMAN indicate open hours on those days, especially during influenza vaccine distribution season;
•	Providers may call McKesson Specialty Customer Care directly only for empty box return coordination;
•	Wasted/expired vaccines get returned to McKesson Specialty Distribution;
•	McKesson Specialty Distribution does not ship direct-ship vaccines but accepts returned expired/wasted direct-ship for excise tax credit processing;
•	Have providers verify open days, hours, and address information each time they submit an order to you;
•	Have providers call you immediately if there is any problem with a shipment so you can alert McKesson Specialty Customer Care and get the issue resolved.  Problems can include a tripped temperature monitor or an inaccurate or incomplete shipment;
•	Influenza vaccines are shipped separately from other vaccines; and
•	For providers that have found vaccine packages left on their doorstep, consider recommending that they cancel their signature release on file; however, such a cancellation applies to all packages (vaccine and otherwise).

CONCLUSION
The guidance provided in this document is designed to support centralized distribution activities as well as to encourage a strong customer service relationship with McKesson Specialty Distribution.  

This document will be updated as the program evolves.  Please also read the weekly VMBIP e-newsletters distributed every Friday in order to stay current with program updates and policy/procedure changes.  VMBIP related all-grantee messages are posted to the VMBIP website at: http://www.cdc.gov/vaccines/programs/vmbip/documents.htm, and previous newsletters are posted at: http://www.cdc.gov/vaccines/programs/vmbip/newsletters.htm.  An additional resource is the “Inventory of Proactive Notifications to Grantees” document first distributed as part of the July 25, 2008 VMBIP e-newsletter.  That document describes all VMBIP-related, grantee-specific, proactive outbound notifications distributed to you by CDC and McKesson Specialty Distribution.  We encourage you to share these resources with your staff and other key stakeholders.  

CDC values your input.  Please provide ongoing feedback on centralized distribution issues to your POB project officer.  

This document can be found on the CDC website at:
http://www.cdc.gov/vaccines/programs/vmbip/downloads/newsletters/downloads/newsletters/ppoc-ug-09-18-08.rtf