PO RE IMMUNIZATIONS WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
C-86-18-018-3-03
ProcureAZ Purchase Order No.: ADHS18-177694:2
Organizational Reference No.: PO0000374320
Issued: 08/02/2018
V Vendor Number: 000010983 Arizona Department of Health Services
E Maricopa County Public Health S Epidemiology and Disease Control Immunization
N 4041 N. Central Avenue, #1400 H Program
Phoenix, AZ 85012 I 150 N. 18th Avenue, Suite 120
D Phoenix, AZ 85007
O P US
R Email: norma.o'loughlin@azdhs.gov
T
O
Contract No.: ADHS18-177694 (602) 364-3630
Title: Maricopa County Immunization Services
MAIL INVOICE IN DUPLICATE TO:
B Arizona Department of Health Services
I AP Services
150 N 18th Avenue, Ste 260
L Phoenix, AZ 85007
L US
Email: INVOICES@azdhs.gov
T
O
(602) 542-6354
Release Instructions
TERMS AND CONDITIONS set forth in our Bid, Quotation, or Purchase Order
are incorporated herein by reference and become a part of this order.
Account Code: 2019--FEDEDC6258--5170--HS2000--HS20000-6811---PHS-EDC- Payment Terms:
IVFCPPHF--0619---------HSA
Shipping Terms: N/A
Delivery Calendar Day(s) A.R.O.: 0
Item Description Requisition Quantity Unit Unit Price Total
Class-Item 948-92
Immunization Program Services CONTRACT# ADHS18-177694 -
MARICOPA COUNTY - Contract End Date - 12/31/2022 - PO Period thru
10/31/2018. PO for the delivery of Immunization services and activities as
follows; * Immunization visit for children zero (0) to eighteen (18) years of
age - UNIT RATE $50.00 * Immunization Completion for children zero (0) to
1 twenty-four (24) months of age for the 4:3:1:3:3:1:4 series - UNIT RATE 1.00 TOTAL $ 671,641.00 $ 671,641.00
$100.00 * Perinatal Hepatitis B Case Management - Prenatal - UNIT RATE
$300.00 * Perinatal Hepatitis B Case Management - Postnatal - UNIT RATE
$200.00 * School/Children IDR Management-Preparation and submittal -
UNIT RATE $250.00 * On-site visit to schools/childcare facilities to validate
IDR submission data - $50.00 * Immunization Visit for adults nineteen (19)
years of age and older - UNIT RATE $50.00 * Immunization Visit for Flu
Vaccine, in children and adults - UNIT RATE $50.00 CFDA# 93.539 *FFATA
certification is required
Class-Item 948-92
2 1.00 TOTAL $ 55,545.00 $ 55,545.00
PANFLU Immunizations

TOTAL: $ 727,186.00
Approved By: Norma O'Loughlin
Phone No.: (602) 364-3649

C-86-18-018-3-03 ATTACHED TO AND A PART OF
Purchase Order ADHS18-177694:2
Contract No. ADHS18-177694
Maricopa County – Immunization Services
IN WITNESS WHEREOF, the parties agree to enter into this Contract:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date