PO RE PRESCRPTN DRUG OVERDOSE PP WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS16-109742:2
Organizational Reference No.: PO0000151582
Issued: 09/02/2016
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.: ADHS16-109742 (602) 364-1400
Title: AZ Prescription Drug Overdose Prevention
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: 2017--FEDCFH6060--4360--HS2000--HS20000-6811--6811-PHS-WCH- Payment Terms: Net 30
RXPREVPROG--0817---------HSA
Shipping Terms:
Delivery Calendar Day(s) A.R.O.: 0
Item Description Requisition Quantity Unit Unit Price Total
Class-Item 948-47
1 PO EFFECTIVE 9/1/16 - 8/31/17 **** CONTRACT EFFECTIVE 9/1/15 - 1.00 TOTAL $ 97,136.00 $ 97,136.00
8/31/20 **** TO PAY FROM FEDCFH6060 / 0817 **** FEDERAL FUNDING
**** CFDA: 93.136 **** WORK TO BE PERFORMED PER CONTRACT
SCOPE OF WORK AND PRICE SHEET ***** AZ Prescription Drug
Overdose Prevention Program
TOTAL: $ 97,136.00
Approved By: Cynthia Ronquillo
Phone No.: (602) 364-1513

C-86-16-039-3-02 ATTACHED TO AND A PART OF
Purchase Order ADHS16-109742:2
AZ Prescription Drug Overdose Prevention
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