HomeMy WebLinkAboutD-15-645 DPH Misc. Docs.pdf COUP
CONTRACT STATUS FORM
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DATE: April 02, 2024 RECEIVED
DIVISION(S): Children's Medical Services JUL 0 8 2024
(Lead Division listed first) DEPARTMENT OF PUBLIC HEAL
CONTRACTOR: Stanford Children's Health CONTRACTS SECTION
SERVICES: Remote Access to Electronic Medical Records
CONTRACT TERM: 10/27/15 to 10/26/24 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201600
CONTRACT AMOUNT: $0.00
Contract#: D-15-645 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:july 1, 2024
Extend contract through:
With no changes in terms or conditions.
With the following change(s):
Evergreen: Continue contract through: LoZO.' , 20
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
upervi orb 1 t: Date:
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Division Pia afi e . Date: 3
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090
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CONTRACT STATUS FORM
RECEIVE o 56 0
DATE: April 03, 2023 APR 2 3 Z Esc'
03
DIVISION(S): Children's Medical Services DEPARTMENTOFPUBLI
(Lead Division listed first) CONTRACTS SECD(A
CONTRACTOR: Stanford Children's Health
SERVICES: Remote Access to Electronic Medical Records
CONTRACT TERM: 10/27/15 to 10/26/23 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201600
CONTRACT AMOUNT: $0.00
Contract#: D-15-645 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:July 1. 2023
❑ Extend contract through: , 20
With no changes in terms or conditions.
With the following change(s):
Evergreen: Continue contract through: 0�0 20
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by. Date:
Program Supervisor/Staff n t: Date:
Division Man Date: 4,2A
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone#: 600-7090
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CONTRACT STATUS FORM co
DATE: April 04, 2022
DIVISION(S): Children's Medical Services RECEIVE
(Lead Division listed first)
CONTRACTOR: Stanford Children's Health MAY 0 2 202
rVEPARTMENT OF PUBLIC ?TH
SERVICES: Remote Access to Electronic Medical Records C WPXTSSECTION
CONTRACT TERM: 10/27/15 to 10/26/22 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201600
CONTRACT AMOUNT: $0.00
Contract#: D-15-645 StateNendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:July 1. 2022
Extend contract through: , 20_
With no changes in terms or conditions.
With the following change(s):
Evergreen: Continue contract through: OCIM&ar 20 X3 .
❑ Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by. 0,5�02- .7-d22
Program Supervisor/Sta t Date:
Division Manager: Date: 2 _Z07— -2
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
o CO V�
CONTRACT STATUS FORM
RECEIVED
O� a O
DATE: April 05, 2021 DEC 14 2021Sz'
DIVISION(S): Children's Medical Services DEPARTMENT OF PUBLIC HEAL H
(Lead Division listed first) CONTRACTS SECTION
CONTRACTOR: Stanford Children's Health
SERVICES: Remote Access to Electronic Medical Records
CONTRACT TERM: 10/27/15 to 10/26/21 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201600
CONTRACT AMOUNT: $0.00
Contract#: D-15-645 State/Vendor#: N/A
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:July 1, 2021
Extend contract through: , 20—
With no changes in terms or conditions.
With the following change(s):
Evergreen: Continue contract through: (1dober 1G , 20 A.
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
Program Sup e al s : �',/ Date:
9
Division Man Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090