PO RE HRPP NEWBORN INTENSIVE CARE PRGM WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS14-074958:4
Organizational Reference No.: PO0000247626
Issued: 07/11/2017
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
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: 2018--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 TOTAL $ 571,000.00 $ 571,000.00
PO EFFECTIVE 7/1/17 - 6/30/18 *** CONTRACT EFFECTIVE 7/1/14 -
6/30/19 *** STATE FUNDING *** THIS LINE TO PAY FROM GENCFH0296
***** HRPP/NICP COMMUNITY HEALTH NURSING SERVICES
Class-Item 948-64
2 1.00 TOTAL $ 4,000.00 $ 4,000.00
THIS LINE TO PAY FROM FEDCFH1787 *** 0918 *** FEDERAL FUNDING
*** CFDA 93.994 ******************* HRPP/NICP COMMUNITY HEALTH
NURSING SERVICES
Class-Item 948-64
3 1.00 EA $ 5,000.00 $ 5,000.00
LINE TO ADD FUNDING THRU 6/30/18 TO PAY FROM GENCFH0296
************ HRPP/NICP COMMUNITY HEALTH NURSING SERVICES

TOTAL: $ 580,000.00
Approved By: Dee Vlahos
Phone No.: (602) 364-1425

C-86-15-021-3-09 ATTACHED TO AND A PART OF
Purchase Order ADHS14-074958:4
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