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HomeMy WebLinkAboutA-07-110 DPH Misc. Docs.pdf co CONTRACT STATUS FORM DATE: October 01, 2024 RECEIVE DIVISION(S): Children's Medical Services OCT 0 2 2024 (Lead Division listed first) DEPARTMENT Of PUBLIC H � CONTRACTOR: Community Regional Medical Center CONTRACTS SECTIO SERVICES: Corporate Information Systems -Access Request Agreeme CONTRACT TERM: 4/17/07 to 4/16/25 E ADDITIONAL INFO: Evergreen Agreement-Please Review ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:January 1, 2025 ❑ Extend contract through: , 20 With no changes in terms or conditions. With the following change(s): Evergreen: Continue contract through: rl /a. i, 2"V Cancel contract effective: , 20 . Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by. Program Supervisor/Staff 4knaly Date: Division Manager: `- Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone#: 600-7090 CO CONTRACT STATUS FORM fp O 83 O DATE: October 02, 2023 E � FRESH' RECEIV DIVISION(S): Children's Medical Services (Lead Division listed first) OCT 13 2 23 CONTRACTOR: Community Regional Medical Cente ENT OfP� p BU H TH A CONTRACTS SEC SERVICES: Corporate Information Systems - Access Request Agreement CONTRACT TERM: 4/17/07 to 4/16/24 E ADDITIONAL INFO: Evergreen Agreement-Please Review ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:January 1, 2024 Extend contract through: , 20 With no changes in terms or conditions. With the following change(s): © Evergreen: Continue contract through: Ap 1 , 20 o26- . ❑ Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Supervisor/Staff t: �4'`' Date: Division Manager: Date: C —o Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 _ co CONTRACT STATUS FORM DATE: October 03, 2022 RECEIVED DIVISION(S): Children's Medical Services JAN 2 3 2023 (Lead Division listed first) DEPARTMENT S SECTION CONTRACTOR: Community Regional Medical Center SERVICES: Corporate Information Systems - Access Request Agreement CONTRACT TERM: 4/17/07 to 4/16/23 E ADDITIONAL INFO: Evergreen Agreement-Please Review ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 Contract#: A-07-110 StateNendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:January 1. 2023 ❑ Extend contract through: , 20 With no changes in terms or conditions. With the following change(s): dEvergreen: Continue contract through: 16 20 ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by. Program Supervisor/Sta ly - - Date: Division Manager: Date: 7� Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 co CONTRACT STATUS FORM O� s6 O DATE: October 01, 2021 RECEIVEDES� DIVISION(S): Children's Medical Services FEB 18 202 (Lead Division listed first) "WENT OF PUBLI ALTH CONTRACTOR: Community Regional Medical Center CONTRACTS SEC SERVICES: Corporate Information Systems -Access Request Agreement CONTRACT TERM: 4/17/07 to 4/16/22 E MEMO ADDITIONAL INFO: Evergreen Agreement-Please Review ORGANIZATION #(s): 56201600 56201601 �T 0 2�i CONTRACT AMOUNT: $0.00 Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:January 1, 2022 ❑ Extend contract through: , 20 With no changes in terms or conditions. With the following change(s): 19/ Evergreen: Continue contract through: b 20 02S ❑ Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Sup yst: Date: 02/�7 Z,2 Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 qW CID CONTRACT_ STATUS FORMfp O� 56 O DATE: October 01, 2020 DIVISION(S): Children's Medical Services RECEN (Lead Division listed first) JAN 2 6 2 21 CONTRACTOR: Community Regional Medical Center DEPARTMENT OF PUBLIC ALTI I SERVICES: Corporate Information Systems -Access ReERMWASTAent CURRENT PERIOD: 4/17/07 to 4/16/21 E Auto-renewal: ❑ through: (If not checkmarked above,contract will terminate ENTIRE TERM: 4/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Evergreen Agreement-Please Review Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:January 1, 2021 ❑ Renew contract through: , 20 ❑ With no changes in terms or conditions. With the following change(s): Evergreen: Continue contract through: ,44201 4e , 20 al V- ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by. Program Supervisor yst: n /Cyr/ r1/ Date: / Wae, Division Ma er: Date: ( 7-- Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 cotj� GnoNTRACT STATUS FCNdM �� O 1g60 DATE: October 01, 2019 �uES� DIVISION(S): Children's Medical Services RECEIVED (Lead Division listed first) OCT 2 2 2019 CONTRACTOR: Community Regional Medical Center DEPARTMENT PUBLIC HEALT CONTRACTS S SECTION DY SERVICES: Corporate Information Systems -Access Request Agreement CURRENT PERIOD: 4/17/07 to 4/16/20 E Auto-renewal: ❑ through: (If not checkmarked above,contract will terminate ENTIRE TERM: 4/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Evergreen Agreement-Please Review Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by-January 1, 2020 ❑ Renew contract through: , 20 ❑ With no changes in terms or conditions. ❑ With the following change(s): [0"'Evergreen: Continue contract through: Agri /� , 20 0?1 ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by. Program Supervisor/Sta I s �'� Date: /0- .X � . / 9 Division Manager: Date: 10. 22,40 q Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 A� co COTRACT STATUS FORM O 560 DATE: October 01, 2018 RECEIVEDiES� DIVISION(S): Children's Medical Services OCT 0 2 2018 (Lead Division listed first) CONTRACTOR: Community Regional Medical Center DEPARTMENT OF PUBLIC TH CONTRACTS SECTIO SERVICES: Corporate Information Systems - Access Request Agreement CURRENT PERIOD: 4/17/2007 to 4/16/2019E Auto-renewal: F through: (If not checkmarked above,contract will terminate ENTIRE TERM: 4/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Per M. Lewis, Agreement to be ongoing as long as CCS program exists. Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:January 1, 2019 Renew contract through: 120 With no changes in terms or conditions. With the following change(s): ❑ Evergreen: Continue contract through: 20 ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Supervisor/Staf A alyst: Date: Division Manag Date: Joh It Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 CO CONTRACT STATUS FOffiM RECEIVED O 56 O DATE: October 02, 2017 FItES� OCT 0 4 201 DIVISION(S): Children's Medical Services DEPARTMENT OF PUBLIC L H (Lead Division listed first) CONTRACTS SECTION CONTRACTOR: Community Regional Medical Center SERVICES: Corporate Information Systems - Access Request Agreement CURRENT PERIOD: 4/17/2017 to 4/16/2018E Auto-renewal: ICI through: (If not checkmarked above,contract will terminate ENTIRE TERM: 4/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Per M. Lewis, Agreement to be ongoing as long as CCS program exists. Contract#: A-07-110 StateNendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:April 1, 2018 Renew contract through: , 20 With no changes in terms or conditions. With the following change(s): Evergreen: Continue contract through: LI , 20 1 , ❑ Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Supervisor/Staff Analyst: Date: 1613,(Q Division Manager: r, Date: / Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090 h�,ti CONTRACT STATUS FORM coU�� DATE: October 03, 2016 RECEIVEDES� DIVISION(S): Children's Medical Services OCT 0 42016 (Lead Division listed first) nn�� CONTRACTOR: Community Regional Medical CentafPARTMENTOF PUBLIC HEALTH CONTRACTS SECTION SERVICES: Corporate Information Systems - Access Request Agreement CURRENT PERIOD: 4/17/16 to 4/16/17 E Auto-renewal: ICJ through: (If not checkmarked above,contract will terminate ENTIRE TERM: 4/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT $0.00 ADDITIONAL INFO: Per M. Lewis, Agreement to be ongoing as long as CCS program exists. Contract#: A-07-110 State/Vendor M N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by:January 1, 2017 Renew contract through: , 20 With no changes in terms or conditions. With the following change(s): Evergreen: Continue contract through: 20 S Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): f Approved by: Program Supervisor/Staff Analyst: Date: � ! t Division Manager: Date: /o Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 co CONTRACT STATUS FORM DATE: October 01, 2014 R 0 DIVISION(S): Children's Medical Services CCIT 022014 (Lead Division listed first) UFP MENT oN RACOTSSECTION LTN CONTRACTOR: Fresno Community Hospital & Medical Center SERVICES: Corporate Information Systems -Access Request Agreement CURRENT PERIOD: 4/17/14 to 4/16/15 E Auto-renewal: O through: (If not checkmarked above,contract will terminate ENTIRE TERM: 4/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by: January 1, 2015 ❑ Renew contract through: With no changes in terms or conditions. ❑ With the following change(s): Evergreen: Continue contract through: , 20 ❑ Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Supervisor/Staff Analyst: Date: `�" ���Division Manager: 9 v z Date: s Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 co Ck4wATRACT STATUS FM. 4 O� 56 O DATE: September 30, 2013 DIVISION(S): Children's Medical Services (Lead Division listed first) CONTRACTOR: Fresno Community Hospital & Medical Center SERVICES: Corporate Information Systems -Access Request Agreement CURRENT PERIOD: 4/17/13 to 4/16/14 E Auto-renewal: ❑ through: (If not checkmarked above,contract will terminate ENTIRE TERM: 4/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by: January 1, 2014 Renew contract through: , 20 ❑ With no changes in terms or conditions. With the following change(s): Evergreen: Continue contract through: A a -J /C , 20 Z-5" , Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by. Program Superviso tall Analyst: ,— Date: b �� Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 i CO U� CONTRACT STATUS FOR1li O� s6 0 DATE: October 01, 2012 xES� DIVISION(S): Children's Medical Services (Lead Division listed first) CONTRACTOR: Fresno Community Hospital & Medical Center SERVICES: Corporate Information Systems -Access Request Agreement CURRENT PERIOD: 4/17/12 to 4/16/13 E Auto-renewal: ❑ through: (if not checkmarked above,contract will terminate ENTIRE TERM: 4/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by: January 1, 2013 ❑ Renew contract through: 20- ❑ With no changes in terms or conditions. ❑ With the following change(s): Evergreen: Continue contract through: ar� /c� , 20 Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Supervisor ta�Analys — Date: o Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090 v CO i✓� CONTRACT STATUS FORM 36 O DATE: September 30, 2011ES� DIVISION(S): Children's Medical Services (Lead Division listed first) CONTRACTOR: Fresno Community Hospital & Medical Center SERVICES: Corporate Information Systems - Access Request Agreement CURRENT PERIOD: 4/17/11 to 4/16/12 E Auto-renewal: ❑ through: (If not checkmarked above,contract will terminate ENTIRE TERM: 4/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by: January 1, 2012 Renew contract through: , 20_ With no changes in terms or conditions. ❑ With the following change(s): Evergreen: Continue contract through: A 42 �' l cr , 20 1, Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by.- Program Supervisor/ tall Anal `— Date: o Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 445-7090 CONTRACT STATUS FORA DATE: October 01, 2010 FxES� DIVISION(S): Children's Medical Services (Lead Division listed first) CONTRACTOR: Fresno Community Hospital & Medical Center SERVICES: Corporate Information Systems - Access Request Agreement CURRENT PERIOD: 4/17/10 to 4/16/11 E Auto-renewal: ❑ through: (If not checkmarked above,contract will terminate ENTIRE TERM: 4/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Contract#: A-07-110 StateNendor#: N/A Lei4 Dept: DPH Other Dept(s): Complete the info--mation below and return to DPH Contracts by: January 1, 2011 Renew contract through: , 20 ❑ With no changes in terms or conditions. ❑ With the following change(s): Evergreen: Continue contract through: ,ramA / , 20 ❑ Cancel contract effective: , 20 ❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Superviso(�Staff Analyst;--' " Date: a c Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 445-7090 � COUP CONTRACT STATUS FORM O 3 0 DATE: October 01, 2009 DIVISION(S): Children's Medical Services (Lead Division listed first) CONTRACTOR: Fresno Community Hospital & Medical Center SERVICES: Corporate Information Systems - Access Request Agreement CURRENT PERIOD: 4/17/09 to 4/16/10 E Auto-renewal: ❑ through: (If not checkmarked above,contract will terminate ENTIRE TERM: 4/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by: January 1, 2010 Renew contract through: , 20 ❑ With no changes in terms or conditions. ❑ With the following change(s): t'�vergreen: Continue contract through: 20 , ❑ Cancel contract effective: , 20 ❑ Addition Information (e.g., anti ated effective date/term, contract extension, etc.): Approved by: Program Supervisor/Staff Analyst: Date: Division Manager: Date: Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 445-7090 co Contract Renewal/Termination Form O 1856 O DATE: October 01, 2008ES� DIVISION(S): Children's Medical Services RECEIVED (Lead Division listed first) JAN 2 3 2009 CONTRACTOR: Community Medical Centers DEPARTMENT OF PUBLIC HEALTH CONTRACTS SECTION SERVICES: Corporate Information Systems - Access Request Agreement CURRENT PERIOD: 4/17/08 to 4/16/09 E Auto-renewal: ❑ through: (If not checkmarked above,contract will terminate ENTIRE TERM: 04/17/2007 to Evergreen at the end of the current period.) ORGANIZATION #(s): 56201600 56201601 CONTRACT AMOUNT: $0.00 ADDITIONAL INFO: Contract#: A-07-110 State/Vendor#: N/A Lead Dept: DPH Other Dept(s): Complete the information below and return to DPH Contracts by: January 1, 2009 Renew contract through: , 20 With no changes in terms or conditions. With the following change(s): �-�— C mc, — 't* vergreen: Continue contract through: 20 Cancel contract effective: , 20 Additional Information (e.g., anticipated effective date/term, contract extension, etc.): Approved by: Program Supervisor/Staff Analyst: Date: Division Manager: Date: �Z Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 445-7090