AMENDMENT NO 1 TO MOU RE HOSPITAL DISCHARGE DATA WITH ADHS.PDF
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ARIZONA DEPARTMENT OF HEALTH SERVICES MEMORANDUM OF UNDERSTANDING (MOU) 1740 West Adams, Room 303 Phoenix, Arizona 85007 AMENDMENT (602) 542-1040 (602) 542-1741 FAX Contract No: MOU HU556030 Amendment No: 1 Procurement Officer Zac Thayer MARICOPA COUNTY HOSPITAL DISCHARGE Effective upon signature of all parties, it is mutually agreed that the Agreement referenced is amended as follows: 1. Pursuant to Amendment or Modifications, Provision 11 (11), Amendment, MOU HU556022 is hereby changed to MOU HU556030. All other Provisions shall remain in their entirety. Contractor hereby acknowledges receipt and The above referenced Agreement Amendment is hereby acceptance of above amendment and that a signed executed this _________ day of ____________________, 2015 copy must be filed with the Procurement Office before at Phoenix, Arizona the effective date. Signature / Date Chief Procurement Officer Authorized Signatory’s Name and Title MARICOPA COUNT DEPARTMENT OF PUBLIC HEALTH Contractor’s Name Page 1 of 1