MURIEL BOWSER
MAYOR
June 7, 2021
The Honorable Phil Mendelson
Chairman
Council of the District of Columbia
John A. Wilson Building
1350 Pennsylvania Avenue, NW, Suite 504
Washington, DC 20004
Dear Chairman Mendelson:
Pursuant to section 451 of the District of Columbia Home Rule Act (D.C. Official Code 1-
204.51) and the Procurement Practices Reform Act (D.C. Official Code 2-351.01 et seq.),
enclosed for consideration and approval by the Council of the District of Columbia is proposed
Modification M004 to contract CW81262 with Magellan Medicaid Administration. The
proposed modification is in the not-to-exceed amount of $5,294,000 for the period of
performance from July 20, 2021 through July 19, 2022.
Under the proposed modification, Magellan Medicaid Administration shall continue to operate,
monitor and administer the pharmacy benefit manager system and pharmacy support services for
eligible District beneficiaries.
I am available to discuss any questions you have regarding the proposed contract. In order to
facilitate a response to any questions you may have, please have your staff contact Marc Scott,
Chief Operating Officer of the Office of Contracting and Procurement, at (202) 724-8759.
I look forward to the Councils favorable consideration of this contract.
Sincerely,
Muriel Bowser
Enclosure
 GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of Contracting and Procurement
Pursuant to section 202(c-3) of the Procurement Practices Reform Act of 2010, as amended,
D.C. Official Code 2-352.02(c-3), the following contract summary is provided:
COUNCIL CONTRACT SUMMARY
(Options)
(A) Contract Number: CW81262
Proposed Contractor: Magellan Medicaid Administration
Contract Amount (Option Period 1): Not-to-exceed (NTE) $5,294,000
Term of Contract: July 20, 2021 through July 19, 2022
Type of Contract: Requirements Contract with Fixed Unit Prices
(B) Identifying number of the underlying contract, including the identifiers assigned to the
underlying contract by the Council for the base period and any subsequent option
periods:
Base Period Amount: NTE $3,082,851
(October 16, 2020 through July 19, 2021)
Council Approval CA24-0011
Option Period 1 Amount: NTE $5,294,000
(July 20, 2021 through July 19, 2022)
(C) A statement that Citywide Clean Hands database indicates that the proposed
contractor is current with its District taxes. If the Citywide Clean Hands Database
indicates that the proposed contractor is not current with its District taxes, either: (1) a
certification that the contractor has worked out and is current with a payment
schedule approved by the District; or (2) a certification that the contractor will be
current with its District taxes after the District recovers any outstanding debt as
provided under D.C. Official Code 2-353.01(b):
On March 23, 2021, the Citywide Clean Hands database certified that the Contractor is
current with its District taxes.
.
1
(D) A statement that the proposed contract is within the appropriated budget authority for
the agency for the fiscal year and is consistent with the financial plan and budget
adopted in accordance with D.C. Official Code 47-392.01 and 47-392.02:
The Department of Health Care Finance Agency Fiscal Officer certified that funding in the
amount of $5,294,000 is available to support the contract for pharmacy benefit management
services.
2
 Government of the District of Columbia
Office of the Chief Financial Officer 1101 4th Street, SW
Office of Tax and Revenue Washington, DC 20024
Date of Notice: March 23, 2021 Notice Number: L0005340903
MAGELLAN MEDICAID ADMINISTRATION INC FEIN: **-***9793
3 CORPORATE SQ NE FL 6 Case ID: 742014
ATLANTA GA 30329-2014
CERTIFICATE OF CLEAN HANDS
As reported in the Clean Hands system, the above referenced individual/entity has no outstanding
CO
liability with the District of Columbia Office of Tax and Revenue or the Department of Employment
Services. As of the date above, the individual/entity has complied with DC Code 47-2862, therefore
this Certificate of Clean Hands is issued.
TITLE 47. TAXATION, LICENSING, PERMITS, ASSESSMENTS, AND FEES
CHAPTER 28 GENERAL LICENSE
SUBCHAPTER II. CLEAN HANDS BEFORE RECEIVING A LICENSE OR PERMIT
D.C. CODE 47-2862 (2006)
PY
47-2862 PROHIBITION AGAINST ISSUANCE OF LICENSE OR PERMIT
Authorized By Marc Aronin
Chief, Collection Division
To validate this certificate, please visit MyTax.DC.gov. On the MyTax DC homepage, click the
Validate a Certificate of Clean Hands hyperlink under the Clean Hands section.
1101 4th Street SW, Suite W270, Washington, DC 20024/Phone: (202) 724-5045/MyTax.DC.gov
 GOVERNMENT OF THE DISTRICT OF COLUMBIA
Department of Health Care Finance
Office of the Chief Financial Officer
MEMORANDUM
TO: George A. Schutter
Chief Procurement Officer
Office of Contracting and Procurement
THRU: Delicia V. Moore
Associate Chief Financial Officer
Human Support Services Cluster
FROM: Darrin Shaffer
Agency Fiscal Officer
Department of Health Care Finance
DATE: March 24, 2021
SUBJECT: PBM Contract - (Magellan) CW81262
The Office of the Chief Financial Officer hereby certifies that the sum of $5,294,000.00 is included in the Districts
Local Budget and Financial Plan submitted to Congress by the Chairman of the Council to the Speaker of the House
of Representatives for Fiscal Year 2021 to fund the costs associated with the Districts pharmacy benefits manager
(PBM) contract. As the PBM, the vendor will administer and maintain a Pharmacy Benefits Management System
with a Point-of-Sale component for eligible District beneficiaries and provide and administer all programs and
services. This certification supports the Magellan CW81262 for the period from 7/20/21 through 7/19/22.
This allocation is as follows:
Vendor: Magellan Contract Number: CW81262
Fiscal Year 2021 Funding: 07/20/21-09/30/21
Agency Fund Program PCA Index CSG Grant/Ph Amount
HT0 0100 6000 O3100 LO310 0409 $212,645.03
HT0 8250 6000 O3100 O31A1 0409 MMAD21/21 $637,935.10
HT0 0100 6000 O3100 LO310 0409 $111,390.05
HT0 8250 6000 O3100 O31A1 0409 MMAD21/21 $91,137.32
FY 21 Contract Total: $1,053,107.50
441 4th Street, N.W., Suite 960N, Washington, D.C. 20001 (202) 442-5988 FAX (202) 478-1373
Fiscal Year 2022 Funding: 10/01/21-7/19/22
Agency Fund Program PCA Index CSG Grant/Ph Amount
HT0 0100 6000 O3100 LO310 0409 $873,965.25
HT0 8250 6000 O3100 O31A2 0409 MMAD22/22 $2,621,895.75
HT0 0100 6000 O3100 LO310 0409 $409,767.32
HT0 8250 6000 O3100 O31A2 0409 MMAD22/22 $335,264.18
FY 22 Contract Total: $4,240,892.50
Upon approval by Congress of the Districts Local Budget and Financial Plan funds will be sufficient to pay for
fees and costs associated with the contract. There is no fiscal impact associated with the contract.
Should you have any questions, please contact me at (202) 442-9079.
441 4th Street, N.W., Suite 960N, Washington, D.C. 20001 (202) 442-5988 FAX (202) 478-1373
 1. Contract Number Page of Pages
CW81262 1 3
AMENDMENT OF SOLICITATION / MODIFICATION OF CONTRACT
2. Amendment/Modification Number 3. Effective Date 4. Requisition/Purchase Request No. 5. Solicitation Caption
Pharmacy Benefit
M004 See Box 16C Manager (PBM)
6. Issued by: Code 7. Administered by (If other than line 6)
Office of Contracting and Procurement DEPARTMENT OF HEALTHCARE FINANCE
441 4th Street NW, Suite 330S 441 4th Street, N.W. Suite 900S
Washington, DC 20001 Washington, DC 20001
Louis Spence-Smith, Contract Administrator (CA)
8. Name and Address of Contractor (No. street, city, county, state and zip code) 9A. Amendment of Solicitation No.
9B. Dated (See Item 11)
Magellan Medicaid Administration
One Columbus Center, Suite 100 10A. Modification of Contract/Order No.
Virginia Beach, Virginia 23462
X CW81262
10B. Dated (See Item 13)
Code Facility 10/16/2020
11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS
The above numbered solicitation is amended as set forth in item 14. The hour and date specified for receipt of Offers is extended. is not extended.
Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:
(a) By completing Items 8 and 15, and returning __________ copies of the amendment: (b) By acknowledging receipt of this amendment on each copy of the offer
submitted; or (c) BY separate letter or fax which includes a reference to the solicitation and amendment number. FAILURE OF YOUR ACKNOWLEDGMENT TO
BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION
OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such may be made by letter or fax, provided each letter or
telegram makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.
12. Accounting and Appropriation Data (If Required)
13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACT/ORDERS,
IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14
A. This change order is issued pursuant to (Specify Authority): 27 DCMR, Chapter 36, Contract Modifications
The changes set forth in Item 14 are made in the contract/order no. in item 10A.
X B. The above numbered contract/order is modified to reflect the administrative changes (such as changes in paying office, appropriation data
etc.) set forth in item 14, pursuant to the authority of 27 DCMR, Chapter 36, Section 3601.2.
C. This supplemental agreement is entered into pursuant to authority of:
D. Other (Specify type of modification and authority)
E. IMPORTANT: Contractor is not is required to sign this document and return 0 copy to the issuing office.
14. Description of modification (Organized by UCF Section headings, including solicitation/contract subject matter where feasible.)
Contract CW81262 is hereby modified as follows:
1. Pursuant to Section F.2 of the contract, the Contracting Officer, hereby exercises Option Period One,
extending the term of the contract for a period of twelve months commencing on July 20, 2021
through July 19, 2022 in the not-to-exceed amount of $5,294,000.00
2. Attachment A: Price Schedule B.3.2 is hereby incorporated and made a part of this contract.
All Other Terms and Conditions remain unchanged
15A. Name and Title of Signer (Type or print) 16A. Name of Contracting Officer
Helena Barbour
15B. Name of Contractor 15C. Date Signed 16B. District of Columbia 16C. Date Signed
(Signature of Contracting Officer)
(Signature of person authorized to sign)
 ATTACHMENT A
PBM
Magellan Medicaid Administration
Modification M004
B.3.2 Option Year One (1) - July 20, 2021 through July 19, 2022
Contract
Estimated
Line Item Item Unit
Unit Amount/
Number Description Quantity Price
Amount*
(CLIN)
As the Districts pharmacy benefits
manager (PBM), administer and
maintain a PBMS with a POS
1001 component for eligible District Month 12 $441,166.67 $5,294,000.00
beneficiaries, and provide and
administer all programs and services, as
described in Section C.5.
Option Year One Operations Cost Total: $5,294,000.00
 PHARMACY BENEFIT MANAGER
Magellan Medicaid Administration CW81262
RECAP
Action Period of Performance (POP) Amount
Letter Contract POP: October 16, 2020 thru January 14, 2021 $660,000.00
Modification M001 Extend the POP of the Letter Contract $330,000.00
POP: January 14, 2021 through January 28, 2021
Modification M002 Letter Contract Extension No Cost
Base Year POP: October 16, 2020 thru July 19, 2021 $3,082,851.00
Modification M003 Living Wage Adjustment 2021 No Cost
Modification M004 Unilateral Change - Option Period One $5,294,000.00
POP: July 20, 2021 thru July 19, 2022
Total Contract Value: $9,366,851.00