PO 15 RE IMMUNIZATION SVCS WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS13-041805:15
Organizational Reference No.: P00000063251
Issued: 12/31/2015
Vendor Number: 000010983 Arizona Department of Health Services
Maricopa County Public Health Epidemiology and Disease Control Immunization
4041 N. Central Avenue, #1400 Program
Phoenix, AZ 85012 150 N. 18th Avenue, Suite 120
Phoenix, AZ 85007
US
Email; procure@azdhs.gov
Contract No.: ADHS13-041805 (602) 364-3630
Title: Marlcopa County - Immunization Services
MAIL INVOICE IN DUPLICATE TO:
Arizona Department of Health Services
Epidemiology and Disease Control Immunization
Program
150 N. 18th Avenue, Suite 120
Phoenix, AZ 85007
US
T Email: procure@azdhs.gov
0
(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: 2015--FEDEDC2546--5172--HS2000--HS20000-6811---PHS-EDC- Payment Terms: Net 30
IMMUVFC--1215 HSA
Shipping Terms:
Delivery Calendar Day(s) A.R.O.: 0
Item Description I Requisition Quantity Unit Unit Price Total
Class-Item 948-92
Immunization Program Services - MARICOPA COUNTY - CONTRACT#
ADHS13-041805 - Contract End Date - 12/31/2017 - PO Period December
31, 2015 thru December 31, 2016, CFDA# 93.268
PO for the delivery of immunization services and activities as follows; *
Salary/Fringe - YEARLY $50,000.00 * Immunization visit for children zero
(0) to eighteen (18) years of age - UNIT RATE $50.00 ' Immunization
1 Completion for children zero (0) to eighteen (18) years of age - UNIT RATE 1,00 TOTAL $ 182,030.00 $ 182,030.00
$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 * 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 $60,00
*FFATA certification is required .

TOTAL: $ 182,030.00
Approved By: Myra Chavez
Phone No.: (602) 364-3649

C-86-13-074-3-08 ATTACHED TO AND A PART OF
Purchase Order ADHS13-041805:15
Maricopa County – Immunization 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
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date