BACKUP FOR INV RE PMT WITH CITY OF MESA FD.PDF

CITY OF MESA - Summary
Title: Childhood Immunization Services Grant
Agreement: C-86-07-058-2
Service Agreement: Administration Fee of $25.00 per Child
Reimbursement: June 3, 2012 - May 31, 2013
Description Number of Kids Total Amount
Medicaid 2,003 $30,045.00
Uninsured 1,280 $19,200.00
American Indian/Alaskan 42 $630.00
Underinsured 191 $2,865.00
KidsCare 98 $1,470.00
Not Eligible (0-18) 1,491 $22,365.00
Total Children Vaccinated: 5,105 $76,575.00
Total Children Not-Allowable ($1,575.00)
Total Billable $75,000.00