PO RE NEWBORN INTENSIVE CARE PRGM WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
C-86-15-021-3-10
ProcureAZ Purchase Order No.: ADHS14-074958:5
Organizational Reference No.: PO0000374219
Issued: 08/02/2018
V Vendor Number: 000010983 Arizona Department of Health Services
E Maricopa County Public Health S Bureau of Women and Children's Health
N 4041 N. Central Avenue, #1400 H 150 N. 18th Avenue, Suite 320
Phoenix, AZ 85012 I Phoenix, AZ 85007
D US
O P Email: procure@azdhs.gov
R
T
O
Contract No.: ADHS14-074958 (602) 364-1400
Title: HRPP Community Nursing - Maricopa County
MAIL INVOICE IN DUPLICATE TO:
B Arizona Department of Health Services
I Bureau of Women and Children's Health
150 N. 18th Avenue, Suite 320
L Phoenix, AZ 85007
L US
Email: procure@azdhs.gov
T
O
(602) 364-1400
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--GENCFH0296--4341--1000--HS43010-6811--6811-PHS-WCH-------- Payment Terms: Net 30
----HSA
Shipping Terms: N/A
Delivery Calendar Day(s) A.R.O.: 0
Item Description Requisition Quantity Unit Unit Price Total
Class-Item 948-64
1 1.00 QTR $ 185,200.00 $ 185,200.00
PO EFFECTIVE 7/1/18 - 10/31/18 *** CONTRACT EFFECTIVE 7/1/14 -
6/30/19 *** THIS LINE TO PAY FROM GENCFH0296 ********
HRPP/NICP COMMUNITY HEALTH NURSING SERVICES
Class-Item 948-64
2 1.00 QTR $ 6,500.00 $ 6,500.00
THIS LINE TO PAY FROM FEDCFH1782/ 0919 ******** HRPP/NICP
COMMUNITY HEALTH NURSING SERVICES
TOTAL: $ 191,700.00
Approved By: Dee Vlahos
Phone No.: (602) 364-1425

C-86-15-021-3-10 ATTACHED TO AND A PART OF
Purchase Order ADHS14-074958:5
High Risk Perinatal Program (HRPP)
Newborn Intensive Care Program (NICP)
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