ADHS IMMUNIZ DISEASE CONTL (09).PDF

Page 1 of 3
ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS13-041805:19
Organizational Reference No.: PO0000169347
C-86-13-074-3-09 Issued: 10/31/2016
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: procure@azdhs.gov
T
O
Contract No.: ADHS13-041805 (602) 364-3630
Title: Immunization Services - Maricopa County
MAIL INVOICE IN DUPLICATE TO:
B Arizona Department of Health Services
I Epidemiology and Disease Control Immunization
Program
L 150 N. 18th Avenue, Suite 120
L Phoenix, AZ 85007
US
T Email: procure@azdhs.gov
O
(602) 364-3630
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: 2017--FEDEDC6258--5170--HS2000--HS20000-6811---PHS-EDC- Payment Terms: Net 30
IVFCPPHF--1216---------HSA
Shipping Terms:
Delivery Calendar Day(s) A.R.O.: 0
Item Description Requisition Quantity Unit Unit Price Total
Class-Item 948-92
Immunization Program Services CONTRACT# ADHS13-041805
MARICOPA COUNTY - Contract End Date - 12/31/2017 - PO Period thru
3/31/2017. PO for the delivery of Immunization services and activities as
follows; * Salary/Fringe - YEARLY $50,000.00 * Immunization visit for
1 children zero (0) to eighteen (18) years of age - UNIT RATE $50.00 * 1.00 TOTAL $ 335,955.00 $ 335,955.00
Immunization Completion for children zero (0) to eighteen (18) years of age
- UNIT RATE $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 * 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

TOTAL: $ 335,955.00
Approved By: Myra Chavez
Phone No.: (602) 364-3649
2 of 3

C-86-13-074-3-09 ATTACHED TO AND A PART OF
Purchase Order ADHS13-041805:19
Maricopa County – Immunizations Services
Arizona Department of Health Services
IN WITNESS WHEREOF, the parties agree to enter into this Contract:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Clint Hickman
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date
3 of 3