Pre Go-Live Site Visit Core Information

Slide 1
Vaccine Management Business Improvement Project (VMBIP)
CDC logos
Pre Go-Live Site Visit 

Slide 2
In today’s discussion we would like to…
4	Provide a brief overview of the Vaccine Management Business Improvement Project (VMBIP) 
4	Discuss roles and responsibilities under centralized distribution 
4	Discuss the data transmission process between CDC and McKesson 
4	Discuss funds management under centralized distribution

Slide 3
We would like to share a quick overview of the Vaccine Management Business Improvement Project (VMBIP)
4	VMBIP: comprehensive review of how public vaccine is managed
4	The first “top-to-bottom” study conducted since inception of VFC in 1994 — many existing processes established over a decade ago
4	Several factors drove need for the assessment
–	Implementation of a national pediatric stockpile 
–	President’s Management Agenda and HHS goals to drive efficiency and reduce costs 
–	Operational changes for distributing Direct Assistance funds to states
–	Ongoing need to improve vaccine management activities
4	Initial recommendations expected to significantly improve operations…
–	Enhance capabilities to respond to public health crises
–	Improve operational efficiency 
4	Immunization program managers have helped shape the recommendations

Slide 4
VMBIP is revolutionizing public-sector vaccine management while delivering significant financial benefits 
Distribution
•	Centralized distribution of vaccine from 2 -3 locations
•	Eliminates need for multiple state and local depots
•	Reduces storage risks and distribution costs
Stockpile
•	Migration of a portion of Pediatric Stockpile offsite
•	Reduces storage cost and ensures vaccine availability
Vaccine Management Enterprise System (VTrckS)
•	Web-based provider ordering and automated approvals 
•	Improved operational efficiency 
•	Improved Internal Controls
•	Resilient, recoverable, standardized system
Internal Efficiencies
•	Funding flows through “single account” instead of 64 grants
•	Improved inventory management results in enhanced visibility and significant savings
•	Reduced administrative processes
•	Process Improvements and CQI

Slide 5
Centralized Distribution Recap
•	First grantee transitions 2/5/07
•	37 grantees transitioned by 12/17/07
•	Pause for CQI implementation 12/17/07 – 2/25/08
•	3 additional CQI teams formed mid-February
•	Sacramento Distribution Center opened 2/25/08
•	Rollout resumed 2/25/08
•	Rollout to be completed by 6/30/08

Slide 6
How are we addressing challenges?
4	Using alternate data sources to monitor performance and communicate results to grantees
4	Regularly scheduled CDC and McKesson meetings to formulate and implement solutions
4	Major enhancements at McKesson
4	Pause in rollout schedule
4	Continuous Quality Improvement (CQI)
–	The team shared preliminary results of the analysis with CA, CDC, and McKesson
–	Will use data to make other programmatic enhancements
–	Grantee survey of issues needing further attention
4	VMBIP Reports

Slide 7
The CQI teams have been reviewing existing processes and developing recommendations for improvement
CQI Initiatives
Initiative: Information and Product Shipment Integrity
Scope: Identify and correct root causes for discrepancies between lot number/expiration date on packing materials, shipment information and actual product
Initiative: Cold Chain Monitoring and Standardization
Scope: Identify and correct root causes of potential failures in the cold chain process – focusing primarily on product in-transit
Initiative: Data, Systems, and Reporting Issues
Scope: Identify potential gaps in IT systems and reporting between grantees, CDC and McKesson

Slide 8
For each of the grantees below, noted are the go live date, grantee name, and project officer name.

2/5/07
Maryland
Jack Nemecek

2/5/07
Washington
Anne Lutz

2/13/07
Chicago
Victoria Wright

2/19/07

WASHINGTON'S BIRTHDAY

3/19/07
California
Jack Nemecek

3/2-3/16

PILOT RUN-TIME

3/19/07
Tennessee
Harry McKnight

3/23-3/30
PILOT RUN-TIME

4/2/07
Rhode Island
Gayle Daniels

4/9-4/20

PILOT RUN-TIME

4/23/07
Nebraska
Mimi Larzelere

4/23/07
Oklahoma
Anne Lutz

4/30/07
Hawaii
Gabe Anaya

4/30/07
Arizona
Mimi Larzelere

5/7/07
Virginia
Victoria Wright

5/14/07
Indiana
Gayle Daniels

5/14/07
Philadelphia
Jack Nemecek

5/21/07
Pennsylvania
Jack Nemecek

5/29/07
New York City
Lewis Anderson

6/4/07
District of Columbia
Gayle Daniels

6/4/07
Delaware
Mimi Larzelere

6/11/07
Kansas
Jack Nemecek

6/11/07
Connecticut
Mimi Larzelere

6/18/07
Missouri
Jack Nemecek

6/25/07
Nevada
Mimi Larzelere

7/2/07
Maine
Gayle Daniels

7/9 -7/16

BYE WEEKS

7/23/07
Idaho
Lewis Anderson

7/23/07
Kentucky
Harry McKnight

7/30/07
Wyoming
Lewis Anderson

8/6/07
Colorado
Anne Lutz

8/6/07
Oregon
Victoria Wright

8/13/07
North Dakota
Victoria Wright

8/13/07
New Jersey
Jack Nemecek

8/20/07
West Virginia
Victoria Wright

8/27/07
Utah
Anne Lutz

8/27/07
Montana
Victoria Wright

9/4/07
Texas
Harry McKnight

9/10/07

BYE WEEK

9/17/07
Minnesota
Anne Lutz

9/24/07

BYE WEEK

Oct-Nov

FLU VACCINE DISTRIBUTION

12/10/07
New Mexico
Lewis Anderson

12/17/07
New York
Lewis Anderson

12/17/07
North Carolina
Mimi Larzelere

Dec-Feb

CQI IMPLEMENTATION

2/25/08
Ohio
Gayle Daniels

3/3/2008
Iowa
Mimi Larzelere

3/3/08
San Antonio
Harry McKnight

3/10/08
Mississippi
Harry McKnight

3/17/08

NIC BREAK

3/23/08
New Hampshire
Gayle Daniels

3/31/08
Louisiana
Harry McKnight

3/31/08
South Dakota
Victoria Wright

4/7/08
Florida
Mimi Larzelere

4/14/08

BYE WEEK

4/21/08
Alabama
Gayle Daniels

4/28/08
Georgia
Anne Lutz

5/5/08
US Virgin Islands
Gabe Anaya

5/5/08
Puerto Rico
Gabe Anaya

5/12/08
Michigan
Anne Lutz

5/12/08
South Carolina
Harry McKnight

5/19/08
Illinois
Victoria Wright

5/26/08

MEMORIAL DAY

6/9/08
Wisconsin
Lewis Anderson

6/16/08
Arkansas
Lewis Anderson

6/16/08
Vermont
Gayle Daniels

6/23/08
Massachusetts
Anne Lutz

6/30/08
Alaska
Lewis Anderson

6/30/08
Samoa
Gabe Anaya

6/30/08
Micronesia
Gabe Anaya

6/30/08
Guam
Gabe Anaya

6/30/08
Marshall Islands
Gabe Anaya

6/30/08
North Mariana
Gabe Anaya

6/30/08
Palau
Gabe Anaya

Slide 9
Please ensure that those who need to receive information on VMBIP are included in the NCIRD Immunization Grantee mailbox
4	VMBIP information and updates are currently distributed to grantees through the NCIRD Immunization Grantee Mailbox. 
4	There may be key VMBIP personnel at the grantee level who are not receiving these messages. 
4	Please provide CDC with a list of email addresses that you would like added to the distribution list for VMBIP messages. 
4	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. 
4	Please forward your list of email addresses to your POB Project Officer

Slide 10
There have been many changes and additions to activities under centralized distribution
4	The next section of information describes changes or additional activities for grantees once they transition to centralized distribution
4	This information came from the Project Point of Contact (PPOC) document which is a user’s guide to communications and activities between the PPOC, McKesson, and CDC
4	The information on the following slides has been paraphrased from this PPOC document

Slide 11
There may be times after transition that provider orders are held at the CDC…
Why Orders are held at CDC?
•	No funding in the grantee NIPVAC account
•	VACMAN Error
•	NIPVAC Error
What should a grantee do?
•	Contact your POB project officer if you receive a message stating “Held at CDC” or “Pending CDC approval”
•	Regularly check status in VACMAN
•	Please note that the same message may occur if the grantee does not correctly download and deposit update files to the RCV folder

Slide 12
And possibly at McKesson
Why orders are held at McKesson?
•	Vaccine temporarily out of stock
•	Restricted days and hours of operation at the provider site
•	Grantee exceeds allocation in shortage situation
•	Federal holiday
•	Grantee requests non-shipment to all providers for a specific period of time 
•	Grantee requests temporary non-shipment to specific zip codes due to extreme acts of nature
•	3-5 day shipping metric
What should a grantee do?
•	It is your responsibility to ensure providers’ open day/hours and addresses are correct in VACMAN
•	In the event that the provider’s office is closed for an extended period of time, do not place an order until the provider returns and can accept delivery
•	McKesson should not be asked to hold orders
•	Call McKesson Specialty Customer Service

Slide 13
How should provider order delivery and returns be handled?
Provider Order Delivery and Returns Guidelines
Reason: A delivery or a provider order is delayed or thwarted due to incorrect hours, days, or address
Guideline:
•	McKesson will notify you (by phone or email) of the reason for the delay within two workings days after failed delivery
•	The order will be returned to McKesson if it cannot be delivered
•	If returned, McKesson will automatically ship a replacement to the provider; therefore do not place a replacement order in VACMAN
•	Implement on-going system to ensure provider addresses and hours of operation are up-to-date
Reason:  The provider refuses to accept the vaccine shipment
Guideline:
•	The carrier documents the date, time and intended recipient of the package
•	Returns the vaccine shipment to McKesson
Reason: The provider receives more vaccines than was ordered
Guideline:
•	Please arrange to have the vaccine transferred
•	The provider should contact you to transfer vaccine from one provider to another
•	Viable vaccine cannot be returned to McKesson Specialty
•	Inform McKesson customer service of the overage

Slide 14
What is the process for vaccine handling, compromised vaccine and/or temperature monitor issues?
4	Providers must open vaccine packages, check the temperature monitor reading, inspect the vaccine and store at appropriate temperatures immediately after the package is delivered

4	If temperature monitor is tripped, customer service must be notified within two hours of provider signing for vaccine

4	Immediately contact McKesson Specialty Customer Care in the event a provider informs you that a vaccine shipment has been compromised

Slide 15
Can Urgent (Priority) Orders be placed once transitioned to centralized distribution?
Process for Urgent (Priority) Orders
Urgent (Priority) Order
•	Orders are placed ahead of routine orders
•	McKesson will work with you to arrange for receipt of shipment on a Friday or Saturday
Placing Order
•	Check the “Urgent Order” box in VACMAN
•	Failure to do so makes it difficult to track, bill and ship order
After Order Transmission
•	After order is transmitted, call or email customer care to ensure the order is being treated as urgent, including requests for Thursday shipment for Friday delivery
Public Health Emergency
•	This is vaccine that is needed immediately
•	Put order in VACMAN and email screen shots of the order to your POB Project Officer
Examples of Urgent (Priority) Orders
•	Example situations include: flooding, disease outbreaks, severe weather
•	Failure to place an order in a timely manner is not an acceptable example of an emergency

Slide 16
What happens in the case of backorders?
Vaccine out at McKesson
•	The corresponding NDC will remain in VACMAN, but please do not place additional orders for that specific product in VACMAN until it is restocked at McKesson
•	Affected orders will appear on the auto-generated backorder report.
Vaccine out at manufacturer
•	CDC will send an email to all grantees notifying you that the item is not available
•	The corresponding NDC will be removed from VACMAN so orders for this product cannot be placed
•	If you have questions about satisfying your providers’ needs for vaccine in the event of backorders, please contact your POB Project Officer

Slide 17
How can a grantee put additional materials in provider shipments?
4	In the event you would like to include materials in vaccine shipments, send an electronic version of the document(s) to CDC at vaccinedistributionc@cdc.gov  (.pdf format is preferred)
4	CDC may limit the number and size of such materials
4	After receipt of CDC approval, you must print and ship a supply of materials to McKesson
4	Vaccine Information Statements (VIS) are not approved materials to include in vaccine shipments

Slide 18
What should a grantee do with a provider’s expired or wasted vaccine?
4	McKesson will accept the return of all nonviable vaccine from providers and shall arrange for the return of nonviable vaccine at no cost to the provider
4	For vaccine that expires prior to transition:
4	Should be processed for excise tax credit by the grantee
4	All product that is shipped by grantee prior to transition, but expires or is wasted after transition can be returned to McKesson for excise tax credit processing
4	All product that is shipped by McKesson after transition can be returned to McKesson for excise tax credit processing

Slide 19
What should a grantee do with a provider’s expired or wasted vaccine?
4	To ensure nonviable vaccine is returned to McKesson and the provider is not charged for return postage, please follow the process below:
4	Have your provider notify you that they have expired/wasted vaccine
4	Have your provider complete and send you a copy of the grantee-specific wastage form (CDC does not provide a standard form)
4	Ensure that your provider includes a copy of the wastage form in the box with the vaccine
4	Call or send an email to McKesson Specialty Customer Care to notify McKesson that nonviable vaccine is available for pickup
4	McKesson will arrange for nonviable vaccine to be picked up

Slide 20
Do providers need to return their boxes?
4	It is recommended that providers return the empty shipment boxes
4	UPS will pick up the boxes to return to McKesson, even when packages are shipped to the providers via another carrier
4	A return label should be included in every vaccine shipment; instruct providers to reverse the flaps to find the return label
4	In the rare event your provider’s box does not have a return label, the provider may call McKesson Specialty Customer Care at 877-822-7746
4	This is the only time it is appropriate for the provider, instead of the PPOC, to have direct contact with McKesson Specialty Customer Care

Slide 21
What should a grantee do during acts of nature (e.g., flood, hurricane, snow, ice storm, tornado, wildfire, etc.)?
4	In order to pause shipments temporarily to providers in affected areas, contact McKesson Specialty Customer Care as soon as possible via email and telephone
4	Please follow up with an email and/or telephone call to your POB Project Officer if the event has funding implications
4	If a shipment is en route and cannot be suspended, or the provider(s) is (are) not available to receive the shipment, please contact McKesson Specialty Customer Care and request that McKesson recall the shipment(s)
4	Please follow up with McKesson to secure a second delivery attempt once affected areas are clear
4	Inform McKesson Specialty Customer Care of zip codes that specific carriers will not reach

Slide 22
What is the process for bulk orders purchased with state/317-FA funds?
4	McKesson receives and ships the following vaccines to providers, in addition to the standard federally contracted vaccine inventory:
4	Non-federal vaccines and biologicals, which include those vaccine presentations (i.e., NDCs) that are not available on the CDC federal contract
4	Federal vaccines purchased with state/local dollars using the federal contract
4	Vaccine presentations that are available on the CDC federal contract, but are purchased with state/local dollars using a non-federal contract
4	To ensure proper management of this inventory, McKesson needs to receive information from grantees detailing incoming purchases.  
4	This information will come from a required Excel spreadsheet that you will complete and submit, per the following instructions (on the next slide).  
4	Do not include direct ship vaccines, rabies, or smallpox vaccine on this spreadsheet
4	This excel spreadsheet is required every time an order is placed for state and 317-FA funded bulk orders, including bulk orders placed through CDC federal vaccine contracts as well as bulk orders placed outside CDC federal vaccine contracts

Slide 23
Sample state and 317 FA-funded bulk order spreadsheet
Grantee:
Date the order was placed:
Grantee Contact Information
Name:
Telephone:
Email:

1.	Save the form as “State and 317 FA Funded Vaccine Purchases for {Grantee Initials} {Date}” and email it to:
Your POB Project Officer
vaccinedistributionc@cdc.gov 
cdc@mckesson.com 
2.	Include the form name as “State and 317 FA Funded Vaccine Purchases for {Grantee Initials} {Date}” in the subject line of the email.

Failure to include the Excel spreadsheet will delay notification of receipt of vaccine by McKesson t the grantee.

The form is divided by Federal Contract and Non Federal Contract Vaccines

Federal Contract 
Includes: 
1) NDCs ordered through VACMAN 
2) NDCs that exist on the Federal Contract but you ordered using a non Federal contract

For every vaccine ordered, grantees must complete the following information:
NCD
Vaccine 
Manufacturer
Brand
Description
Quantity of Doses
Grantee Purchase Order Number
Federal Purchase Order Number – if the order was placed in VACMAN, please include the Federal purchase order (PO) number.  The Federal PO number is listed in VACMAN the next business day after the order is transmitted when you do a download.  If the NDC exists on the Federal contract but you ordered it outside of VACMAN using a non-Federal contract, type “did not order in VACMAN”.

Non Federal Contract 
Includes all vaccines/biologicals that do not exist on Federal Contract

For every vaccine ordered, grantees must complete the following information:
NCD
Vaccine 
Manufacturer
Brand
Description
Quantity of Doses
Grantee Purchase Order Number

Slide 24 
In order to ensure proper inventory, grantees are asked to provide information about state funded bulk orders
Process
Step 1 – Order Placement
•	Please follow your normal process for placing bulk orders both within VACMAN and outside of VACMAN
•	Vaccines should be sent to the address stated below
Step 2 – Communications to McKesson
•	All grantees must fill out this state and 317-FA Vaccine purchases Excel spreadsheet
–	Insert the grantee initials or full spelling at the top of the spreadsheet
–	Provide the name, telephone number and email address of the appropriate contact person for the grantee
–	Provide the date of the order
–	Complete a separate line in the table for each NDC ordered
•	Save form and email it to:
–	Your POB Project Officer
–	Vaccinedistributionc@cdc.gov
–	cdc@mckesson.com
•	Include the “State/317-FA funded vaccine purchases for [Grantee Initials] [date] in the subject line of the email

McKesson Specialty
4853 Crumpler Road
Memphis, TN  38141
Phone: (901) 367-6982
Fax: (901) 366-3825
Shipping Contact: Tommy McRae

McKesson Specialty
3775 Seaport Blvd
West Sacramento, CA  95691
Phone: (916) 373-5280
Fax: (916) 373-5294
Shipping Contact: Randy Mohring

Slide 25
Scanned copies of the packing slip from grantee purchased vaccine will be emailed after the packages have been received.  There was an example in the slide, but it was hard to read and was only there to demonstrate what any given manufacturers’ packing slip might look like.

Slide 26
Out-of-the-ordinary, previously unanticipated, large provider orders for adult vaccines exceeding 3,000 doses per month
•	Before you place the orders in VACMAN, as far in advance as possible send an email to your POB Project Officer and to vaccinedistributionc@cdc.gov with the following information:
–	Brand
–	Presentation (NDC)
–	Number of doses 
•	This communication will give CDC enough time to ensure adequate inventory at McKesson 

Slide 27
Below are other important processes under centralized distribution
Process:  Non Federal Vaccine Inventory
Guideline:  You must monitor grantee specific non-federal vaccine inventory to ensure accuracy, use before expiration, and when to reorder
Process:  Provider Order Cancellation
Guideline:
•	If you notice an error in a provider order in VACMAN, please correct it before you transmit
•	Cancelling an order is a time-consuming, manual process for both the CDC and McKesson
•	If you find you still need to cancel an order, contact McKesson Customer Care immediately (via telephone and email)
•	McKesson will then contact CDC/VSAB for authorization
Process:  Influenza
Guideline:
•	McKesson established an influenza-only vaccine distribution line to help prioritize these orders
•	As a result, influenza may arrive in separate boxes
•	Please notify your providers that this may occur
Process:  CDC Vaccine Allocation
Guideline:
•	In the event of a national shortage, doses will be allocated by VSAB to each grantee
•	It is your responsibility to monitor the doses allocated and not go beyond this allocation
•	You may use VACMAN reports or other tools to help monitor your allocation

Slide 28
With centralized distribution, there are many systems working together to get the provider order to McKesson and back
4	VACMAN
4	NIPVAC
4	Secure Data Network 
(SDN) - FTP site
4	McKesson SAP
4	Daily Shipping Log
4	Daily Backorder Report
4	McKesson TecSys

Slide 29
McKesson’s specific day of shipment is dependent on the day a provider order is received.
4	McKesson is required to ship 80 percent of provider orders within three shipping days and 100 percent of orders in five shipping days.
4	McKesson is currently shipping Monday, Tuesday, and Wednesday
4	Depending on when a provider order is received, McKesson will initiate the shipping process

Scenario 1:
Orders received on Monday, Thursday or Friday 
Week 0 - Order received on Thursday or Friday
Week 1 - Order received on Monday.  Shipping may occur on Tuesday or Wednesday
Week 2 - Shipping may occur on Monday or Tuesday

Scenario 2:  Order received on Tuesday
Week 1 – Order received on Tuesday.  Shipping may occur on Wednesday
Week 2 – Shipping may occur Monday, Tuesday or Wednesday

Scenario 3: Order received on Wednesday
Week 1 – Order received on Wednesday
Week 2 – Shipping my occur on Monday, Tuesday, or Wednesday
Week 3 – Shipping may occur on Wednesday

Slide 30
The range of a provider’s open days and hours may also affect delivery timeframes
Providers’ hours of operation vary considerably.  
Some providers are open every day of the week:  M, T, W, TH, F: MTWTHF 8 to 6
Other provider may be open only one or tow days a week: M, W: M 9 to 4, W 11 to 7
Certain providers may only be open limited days and hours:  TH; TH 1 to 3

Coupled with McKesson’s shipping days, less frequent provider availability may slow the delivery process, causing provider order fulfillment to be delayed. 

Slide 31
A best case scenario for delivery requires the synchronization of order placement, shipping days, and provider availability.

A best case scenario may involve the following:
- CDC transmits order to McKesson on Monday, Thursday, or Friday
- McKesson picks, packs, and ships order in one day
- Provider is open for delivery Monday through Friday, 9:00 AM to 5:00 PM

Week One
Step 1 – Thursday – provider submits order to grantee
Step 2 – Thursday – grantee transmits provider order via VACMAN

Week Two
Step 3 – Monday – CDC processes order through NIPVAC
Step 4 – Monday - McKesson shipping days begin
Step 5 – Monday - McKesson shipping days continue (if needed)
Step 6 – Monday – McKesson picks, packs and ships order
Step 7 – Monday or Tuesday – Carrier picks up filled vaccine order from McKesson
Step 8 – Tuesday – Provider receives orders

Vaccine is delivered in four business days of order placement.

Slide 32
A worst case scenario for delivery may occur if McKesson ships on the fifth shipping day and the provider has limited availability.

A worst case scenario may involve the following:
- CDC transmits order to McKesson Wednesday
- McKesson takes the full five shipping days to pick, pack, and ship the order
- Provider is open for delivery Monday and Wednesday, 1:00 PM to 4:00 PM

Week One
Step 1 – Monday – Provider submits order to grantee
Step 2 – Tuesday – Grantee transmits provider order via VACMAN
Step 3 – Wednesday – CDC processes order through NIPVAC
Step 4 – Wednesday – McKesson shipping days begin

Week Two
Step 5 – Monday through Wednesday – McKesson shipping days continue (if needed0

Week Three
Step 6 – Monday - McKesson picks, packs, and ships order
Step 7 – Monday through Wednesday - Carrier picks up filled vaccine order from McKesson
Step 8 – Wednesday – Provider receives orders

Vaccine is delivered in over two weeks of order placement

Slide 33
Key messages to communicate to providers
•	Different boxes
•	Chemical monitors
•	Acronym on written materials:  PPOC
•	FedEx and UPS shipping; only UPS pick-up (never call carrier directly)
•	Expectation setting: 2-3 week delivery time; instruct providers to submit orders to PPOC to allow for lead time
•	Expect vaccine deliveries on Monday and Friday
•	Providers may call McKesson customer service directly only for EMPTY box return coordination

Slide 34
Key messages to communicate to providers
•	McKesson does not ship direct-ship vaccines
•	Have providers verify open days, hours, and address information each time they submit an order to PPOC
•	Call customer service within 2 hours of receipt for any order exception or temperature monitor issue
•	Have providers call PPOC on Day 1 of partial or split shipment 
•	Flu will be shipped separately from other vaccines
•	Hib may be shipped incrementally throughout the month
•	Expired vaccines after transition get returned to McKesson
•	72-hour shipper 
•	Cancel “signature release on file”?

Slide 35
There are several online resources to help grantee pre and post transition
4	VMBIP website (main): http://www.cdc.gov/vaccines/programs/vmbip/default.htm 
4	VMBIP documents web page: http://www.cdc.gov/vaccines/programs/vmbip/documents.htm 
4	All-grantee messages
4	Link to weekly e-newsletter
4	VACMAN 4.x guidance web page: http://www.cdc.gov/vaccines/programs/vacman/vacman4-x.htm#vmbipdocs 

Slide 36
Spend plans should reflect actual bulk orders prior to transition and expected provider orders after transition
Spend plans at transition
4	Pre-transition, bulk orders by grantees are assigned to a funding source by the grantee and the funds are debited from the appropriate manufacturer budget based on that assignment
4	Post-transition, bulk orders by CDC are assigned to a funding source by CDC based on the expected provider orders from the transitioned grantees’ spend plans
4	In order to ensure funds are apportioned correctly, grantees’ spend plans at transition must reflect actual bulk orders prior to transition and expected provider orders after transition so that VFC allocations and available funds (317 and State) are not exceeded for the fiscal year
4	CDC has extrapolated historical provider distribution data that will be offered to grantees who do not have access to good data of their own.  This data can be used as a starting point for the grantees' VOFA projections but should be adjusted by the grantee based on their project-specific knowledge and available information 

Slide 37
The Grantee Replenishment model will require upfront planning and regular monitoring throughout the year
Before the beginning of the fiscal year
4	RA&M will create a Replenishment Order Schedule for each grantee – also known as the “grantee commitment.”  This schedule will be created using the grantee’s spend plan
4	RA&M and POB Project Officer will then work with the grantee to determine the frequency and the timing the grantee anticipates placing their replenishment order – this should include the month and the week of each order
Throughout the month
4	VSAB will create the monthly Replenishment Reports* at the beginning of each month
–	In the end state, this report will be created automatically
4	Once grantees receive their replenishment report, they should place their replenishment order
–	In VACMAN 4.1.3.1 during transition
–	In VTrckS in the end state
4	If ordering less frequently than monthly, the grantee will wait until that specified time to order
4	POB Project Officer and RA&M will monitor the grantee replenishment reports, looking for grantees who do not follow through on their commitments
4	If a grantee does not follow through with its commitment, communications will begin
* A Replenishment Report is sent to every grantee at the beginning of each month for the previous month’s provider orders
This report will let the grantee know how the orders were broken down by funding source, including their state portion (if applicable).
This portion is what needs to be replenished back to the CDC

Slide 38
Grantees choose the debit card model and/or the credit card (arrears) model for state funded replenishment orders
Grantee and CDC establish spend plan
Ordering information goes to the manufacturers
Manufacturers send physical vaccine to McKesson
McKesson puts vaccine in operating inventory
McKesson sends receipt of goods to grantee

Debit Card Model
Purchase doses prior to being sent to providers, estimating usage
Replenishment Report will show a negative balance in the balance column
Ability to purchase before provider orders are placed

Credit Card Model
Trade doses for doses that have already been shipped to providers from the previous month.  
Replenishment report will show a positive balance in the balance column
Ability to replenish exactly what the providers ordered for that month

This document can be found on the CDC website at:
http://www.cdc.gov/vaccines/programs/vmbip/downloads/pgl-sv-coreinfo.rtf