PO RE IMMUNIZATION SERVICES WITH ADHS.PDF

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ARIZONA STATE CONTRACT
CONTRACT RELEASE
ProcureAZ Purchase Order No.: ADHS13-041805:7
Organizational Reference No.: E0187208
Issued: 08/15/2014
Vendor Number: 000010983 Arizona Department of Health Services
Maricopa County Public Health Epidemiology and Disease Control Immunization
1001 N CENTRAL AVE Program
STE 500 150 N. 18th Avenue, Suite 120
Phoenix, AZ 85004 Phoenix, AZ 85007
US
Email: procure@azdhs.gov
Contract No.: ADHS13-041805 (602) 364-3630
Title: Maricopa 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
Email: procure@azdhs.gov
(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: 14-99486-54000-6811- Payment Terms: Net 30
Shipping Terms:
Solicitation (Bid) No.: Delivery Calendar Day(s) A.R.O.: 0
Item Description I Requisition Quantity Unit Unit Price Total
Class-Item 948-92
Immunization Program CONTRACT# ADHS13-041805 MARICOPA
COUNTY - CONTRACT END DATE - 12/31/2017- PO Period thru
12/3112014.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 Completion for children zero (0) to eighteen (18) years of 1.00 TOTAL $ 683,067.00 $ 683,067.00
age - UNIT RATE $100.00 " Perinatal Hepatitis B Case Management -
Prenatal - UNIT RATE $300.00 * Perinatal Hepatitis B Case Management -
Postnatal - UNIT RATE $200.00 * School/Children 1DR 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
$50.00

TOTAL: $ 683,067,00
Approved By: Myra Chavez
Phone No.: (602) 364-3649
C-86-13-074-3-04 Immunization Services ADHS 13-041805
IN WITNESS WHEREOF, the parties agree to enter into this Agreement:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Deputy Attorney for Maricopa County
Date