‘Tracking Number a YPadhec Providers VAX Secure Invoice Dawe ae Upload fr2rs/2024 Please enter the conract number first to automatically populate the fields listed with an asterisk (*) Please note that these fields are "Read Only” and edits are not permitted on the form. OTH-VAX-576 MHoldings LLC DBA My Pharmacy 83-1454255 7000297256 Gonvaci Number Fequred) *Conaeter Name Taw *SOEIS Number James Hampton Manning Pharmacist, Owner (843) 845-7905, hamp@mypharmacyandopti Conacr Fanaa) ie Prove EXT Contact EMA 808 Highway 378 Suite 8 Lexington sc 29072 pares Tae Tay Toute "Zp INVOICE NUMBER INVOICE AMOUNT 7 185,000.00 Please Upload Invoice for Payment Review ‘To ensure prompt processing of your invoice ensure that you include the invoice number in the file name that you upload. Please ensure that all required information is included on the invoice. Click below for more details Please upload the invoice PDF to our secure website using the buttons below. ‘email confirmation of intial deposit_wire transfer * My Pharmacy_invoice 17 expense explanations_mobile RV unit_ deposit COVID19 Vaccine Reimbursement Calculator_invoice 17_RV deposit, WIRE transfer_mobile rv deposit 12.06.21 ¥ | cetiy that no other funds have been Signature (required) Click to Sign received or will be reimoursed by any “Janes Hampton Manning ‘ther souree for the amounts claimed on trisio001 348-38 PM this invoice Yes $488,000.00 © Ye* se attached invoice i acute and the invoice totals correct. Tavoice Total One ‘Approved Funding ACC Testing Approval Budget and Finance Approval Bonner, Melissa Samuels, Terra B. Approved Invoices to Date 12N612021 8:34:45 AN s2js6r2021 1:48:05 PM ‘Availible Funding $0.00 Payment Processing Instructions Full Amount §185,000.00 ‘31070000 Not Relevant ‘Accounts Payable Approval \J0402Az998 J040X01058580130 502310000 98000018If rejecting this form for any reason please provide a brief note tothe agency. It wil be included in the rejection email notificationFrom: brenttmoharmacvandontica.com To: “Jo Coblentz’; namogmypharmacyandopic.com ce: Lee Guse" “Kann Prater’ "Ken Guse;*Shecry Worthington Subject: RE: Leington SC My Pharmacy - Mobile Unit Purchase and Re-Fiting| Date: “Tuesday, December 7, 2021 7:53:26 AM Thank you From: John Coblentz Sent: Tuesday, December 7, 2021 7:46 AM To: brent@mypharmacyandopti Ce: Lee Guse ; Karyn Prater ; Ken Guse ; Sherry Worthington Subject: Lexington SC My Pharmacy - Mobile Unit Purchase and Re-Fitting Dear Mr. Munnerlyn: ‘As promised, Brent, this confirms receipt of your $185,000 wire transfer yesterday. Thank you and regards, LifeLine John Cobientz LifeLine Mobile, Inc. 2050 McGaw Road Columbus, OH 43207 Direct: 614-669-3106, Mobile: 630-253-8839 Email: JohnCoblentz@Lifel ineMobile.com From: Lee Guse Sent: Friday, December 03, 2021 4:56 PM To: brent @mypharmacyandoptical.com Ce: Karyn Prater ; Ken Guse ; John Coblentz Subject: Lexington SC My Pharmacy - Mobile Unit Purchase and Re-Fitting Mr, Munnerlyn: Thanks for calling this afternoon regarding a payment for the eventual ownership of the near-ready mobile unit that we have in stock. ‘The attached invoice is for the complete cost based on the up-ting on Version 7 guidance materials attached, Brent. If you choose to make payment for the entire vehicle, we will turn the vehicle title over to you once your payment clears in order to facilitate your ability to register and insure the vehicle. On the ‘other hand, if you choose to pay one-haif of the total now, and the other half when the vehicle is delivered to you, we will accept that arrangement. Whichever you choose, we will need your payment in order to start re-fiting the vehicle and time is of theessence. For payment, you may send a paper check, or wire transfer. For wire transfer instructions, please contact, ‘our John Cobientz at 614-669-3106, or by email at johncoblentz@lifelinemobile. com. Accept no wire instructions from anyone except Mr. Coblentz, and do not accept any changes to the instructions once he provides them to you. It you prefer to make payment via overnight service, send the payment to me at the address below, please. We're excited to get started on the upefitting! Thanks and regards, LifeLine! K. Lee Guse LifeLine Mobi, Inc 2050 McGaw Road Columbus, OH 43207 T: B00-678-LINE (5469) ext 103 Drect: tesosst03 Mobile: 614-296-7300 Emalt LesGuse@ febineMobie com “| This email has been checked for viruses by Avast antivirus software. www avast.comMy Pharmacy 808 Hwy 378 Ste B Lexington, SC 29072 Invoice #17 Additional Expense Explanation-Mobile RV Vaccine Unit Deposit Only Explanation of expenses for covid 19 IMZ Mobile RV Unit General description: This expense submission is for the approved deposit ($185,000) on the mobile RV unit we submitted to DHEC prior to proceeding forward with the purchase. Our outreach into the community has been well received and we have noticed that there has not been a lot of access available. For example, Sun City had not been able to find a vaccine provider after multiple attempts until we reached out to them. We were able to schedule 78 nursing home facilities due to CVS/Walgreens not providing access for boosters. We are well positioned to provide improved access to care as we currently have a staff of 52 that are dedicated to COVID testing and vaccination. We ramped up staffing to address the need in nursing homes & assisted living facilities and as this workload tapers off in December, our effort to vaccinate residents in SC will require a change in strategy. This unit will allow us to provide increased access to care in rural SC. Our current drive thru model has worked well for higher population density areas in strong traffic corridors, however, rural SC we believe is going to require a different effort. We see rural SC requiring a strong mobile vaccination effort in which we set up indifferent areas of rural SC to improve access. We know from experience that people will more likely get vaccinated if the opportunity to vaccinate is convenient and centered around community. We have partnered with several community leaders in rural SC already establishing community events that have allowed hundreds of vaccinations to occur that otherwise would have been missed. With all of this in mind we are looking at a mobile clinic that is wheelchair accessible and allows for higher patient volumes. Our current mobile unit has been extremely helpful, however, itis not wheelchair accessible and we cannot efficiently vaccinate medium to large groups. The mobile unit we currently have has attracted a multitude of people at local events and it has brought @ level of professionalism that has helped improve patient conversions. This Unit is wheelchair accessible and provides a larger area for vaccination and a private room for persons showing up with improper clothing or those requesting additional privacy. Our plan is to focus the efforts of this unit in rural SC and larger retirement communities. This has benefited and will continue to benefit South Carolina's COVID 19 vaccination effort due to our ease of access to the public by coming to them, advertising extensively to underserved populations, and providing access throughout the state. We provide a high quality and very efficient process for patients to be vaccinated in a professional exam lane environment in our mobile unit. The below submitted costs are not being covered by any other funding source and have been fully paid for by our business. All other avenues were exhausted before using this fund. Thank you! Hamp Manning, PharmD/Owner Brent Munnerlyn, PharmD/OwnerCOVID-19 Vaccination Reimbursement Request Community Vaccination Event Information* Provider Name: M Holdings DBA My Pharmacy COVID-19 Vaccine Pin Number: 932016 Location Name: My Pharmacy-Mobile RV Location Address (ine! zip) £808 Hwy 378 Ste B Lexington, SC 29072 Date & Times: TBD Total # Vaccinations: 0 Eligible Vaccinations**: 0 Please select yes or no to the following questions to determine eligible reimbursement: Yes __ Did your organization provide event management, traffic control and logistics for this event? Yes Did your organization provide administrative staff for this event? Yes Did you organization provide vaccination staff for this event? Reimbursement Calculator en rate_| gemburemert Event Mgmt, Traffic, Logistics $10 $0] [Administrative Staff $5, E [Vaccination staff $15 $0 Total Event Reimbursement Amount $0 Additional Cost Summary***: Total additional cost: $185,000.00 Less other funding/reimbursement: Net additional cost: '$185,000.00] Total Request Amount: $185,000.00 * Community Vaccination Events may span multiple days as long as the event location remains the same. All dates should be specified. ** If seeking third-party reimbursement for the services at the event was not appropriate or feasible, then all vaccinations are eligible for reimbursement. | billing third party payers was feasible, then only vaccinations not eligible for insurance reimbursement are eligible for Staffing Reimbursement.*** Claiming additional costs requires detailed justification and documentation. Please attach answers to the following. questions: 1) Summary Description of Request and Costs 2) Describe Benefit to the State of South Carolina and Statewide Vacinnation Efforts including the future distribution and administering of vaccines. 3) Describe activities conducted and outcomes expected or achieved 4) Is the cost being covered by any other funding source or insurance?_ Please explain. 5) Were all avenues of funding exhausted before using Vaccine Reserve Account funds? Please explain.Vomesue Ware Lranster = Domestic Outgoing Wire Lranster age | ot | peeeeererece torn Anquitry Id=2212061903S58H100 ‘Soom The Customer Signature Is required=-----* Iprrutarietet gory eters mee amet eee aftiren that the Information contained below concerning the requested wire transfer We correct, and I hold the Sank harmiass if the Bank's ‘tis Information rasults in an error whereby the transtar Is went In Customer Signature: Wire Information ta aa Tet “Hane pa tone Tne | tonal ee ren ies anewel i tie aiiemonsco [oxiainatr Ascound 09161943679 customer Inlating Wire” °M HOLDINGS Lz ‘The wire may be sent In the name of the primary account holder of business name, Which may be different from the ihame of the Sender/Originator Initiating the wite ‘Name on Wire Transfer Christopher Brent Ts there a Wire Transfer Agreement: Munnertya Agreement on fle [Name on Wire Transfer | Agreement Vertiedt Branch # or Location: 0085 Identification Information Residency Status [Taxi Veritiea: Y Company Account Number Verified? Contact Phone Number Verified? ‘Account Open Date Verified? Y ‘Account Breach Location Verttied?: Recipient/Beneficiary Bank Information Bank ABAY azg003i6 Bank Name: FIFTH THIRD BANK, NATIONAL ASSOCIATI Beneficiary Account Number: 7283969751 Beneficiary Account Name Life Line Mobile | [Address Line 4: 192 Schrock Ra ‘Address Line 2: Westenville, OH 43082 Second Bank If applicable Second Sank ABA Number: ‘Bank Name: = ‘Address: ity: 180 Country Code: us ‘Additional Xnformation ‘Additional Information: —__REF: Involce#: 202XTEO hetp://intranet.feb.com/domesticwire/execute/manageDomestic Wire 12/6/2021LifeLine Mobile 2050 McGaw Road Columbus, OH 43207-4800 Ph: 614-497-8300 Fax: 614-497-9956 To Invoice Number: 2021449 LifeLine Ship To Date: 06-Deo-21 Mr. Brent Munnerlyn 808 Highway 378 Lexington, SC 29072 My Pharmacy & Optical My Pharmacy & Optical 808 Highway 378 Lexington, SC 29072 Ph: 808-261-8615, Terms Due Date ‘Salesperson ‘Quantity | Description Unit Price Amount 1] Chassis Deposit -LifeLine unit Job: 2021101 $185,000.00] $185,000.00 Final payment of $184,807.00 plus or minus any changes or eredits willbe due at delivery Total Purchase Price: $369,807.00 Invoice Total: $186,000.00 ‘Amount Paid: $0.00 ‘Amount Due:| $185,000.00 Page 1 aftYPdhec Healthy People. Healthy Communities 16/2021 ‘To whom it may concem: ‘As pattof the COVID-19 response, DHEC has many paztnersand vendors who areassisting with testing, contact tracing, and othercritical response activities, In order to maintain good working relationships with all our partners and vendors, as well as avoid interruption in services provided, we are requesting the ability process all invoices, related to COVID-19 asa Zspecial to expedite payments. Ifyou need additional detail or have any questions or concems regarding these invoices, please do nothesitateto reach out to ACC-FinAdmin@dhee segov. Sincerely, (os (MPR Darbi C MacPhail, MHA Chief Finance and Operations Officer SC Department of Health and Environmental Control ‘SC. Department of Health and Environmental Control 2600 Bull Street, Columbia, SC 29201 (803) 8983432 wwwscdhecgov