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Toolkit: Transitions of Care Management Contracting


Please see PPA's "Getting Started" toolkit (http://www.papharmacists.com/?page=GettingStarted) and operational resources for a basic understanding or laws, regulations, business plans, and logistics of setting up a practice.


Once agreements are made between hospitals/health systems and pharmacies to provide transitional care services, contracts need to be drafted between sites.  Here are some areas to consider in the contract when drawing up a relationship:


Disclaimer- this material is to be used as a guiding tool and is not meant to replace legal or business advice. Modify as needed.


  • Once you establish a relationship with a collaborator (hospital and community pharmacy) you can expect to have an agreement between the two parties.
  •   If you are not a covered entity under HIPAA, you may be asked to sign a Business Associate Agreement to cover the transfer of Protected Health Information between parties. As with any legally binding document, it is advised to have legal counsel review and negotiate prior to signing
  • Expect an agreement to address the following.  Please note: agreement language is not limited to the sections below:

o    Duties and Responsibilities of each party (pharmacy and hospital)

o    Compensation, if applicable

o    Ownership, if terms apply

o    Data use, abiding by Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Health Information Technology for Economic Clinical Health Act (HITECH Act)

o    Confidentiality

o    Term and termination language

o    Indemnification and Insurance requirements

o    PA Act 94, if either party is located in Pennsylvania

o    General Provisions – consult your legal representation and include any standard terms and conditions required by the organization

o    Statement of Work (SOW)- should summarize expectations of both parties.  Include specific requirements for the relationship to accomplish the overarching goals.

o    Notice section

·         Contact information to send notices to

§  May include legal, billing, or agreement notice


In addition, NCPA provides some resources for members on how to develop legal relationships between pharmacies and hospitals. See: http://www.ncpanet.org/innovation-center/diversified-revenue-opportunities/transitions-of-care

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