ADHS OH 3RD PARTY PE.PDF

Maricopa County — Formal (2016-06-08)

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C-8646-080-3- C,3
ADHS16423017
AMENDMENT 210 INTERGOVERNMENTAL AGREEMENT
Between MARICOPA COUNTY By and Through
DEPARTMENT OF PUBLIC HEALTH, Office of Oral Health,
And Arizona Department of Health Services for
Third Party Reimbursement for Fluoride Varnish Services
The above named contract is hereby amended for Year Two 2) as specified below:
5. Start Date: July 1, _2016
6.. Expiration Date: June 30, 2017
Section III
4 Tasks
L. Generated revenue for MCDPH is estimated not to exceed $300,000.00 for the
Budget Period July 1, 2016 through June 30, 2017.
All other terms and conditions of the original contract shall remain in full force and effect,
IN WITNESS WHEREOF, the parties agree to the changes Indicated herein:
FOR AND ON BEHALF OF FOR AND ON BEHALF OF
MARICOPA COUNTY Arizona Department of Health Services
By: By:
Clint Hickman, Chairman, Board of Supervisors
Date Date
ATIEST ATTEST
Clerk of the Board
Date Date
APPROVED AS TO FORM APPROVED AS TO FORM
Attorney for Maricopa County
/-D4
Date Date