HomeMy WebLinkAboutA-14-084 DPH Misc. Docs.pdf ti CO U�
CONTRACT STATUS " n
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O 18s6 O
DATE: September 01, 2020 SEP 11 xREs�
DEPARTMENT OF PUBLIC HEALTH
DIVISION(S): Community Health CONTRACTS SECTION
(Lead Division listed first)
CONTRACTOR: STATE: HHS Agency, Office of Statewide Health Planning and
Development
SERVICES: Diabetes Morbidity Project/Request for Nonpublic Patient Level Data
CURRENT PERIOD: 3/4/14 to 3/3/21 E Auto-renewal: ❑ through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 3/4/2014 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201653
CONTRACT AMOUNT: $0.00
ADDITIONAL INFO: Evergreen Agreement-Please Review
Contract#: A-14-084 State/Vendor#:
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:December 1, 2020
❑ Renew contract through: , 20
❑ With no changes in terms or conditions.
❑ With the following change(s):
Evergreen: Continue contract through: 20 2—,
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Supervisor/Staff Analyst: T ate:
Division Manager: Date: L
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
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CONTRACT STATUS. FORTU
RECEIVED o g6 0
DATE: September 01, 2017 �uES�
sEP 112017
DIVISION(S): Community Health
(Lead Division listed first) DEPARTMENT OF PUBLIC HEAL
CONTRACTS SECTION
CONTRACTOR: STATE: HHS Agency, Office of Statewide Health Plann g and
Development
SERVICES: Request for Nonpublic Patient Level Data
CURRENT PERIOD: 3/4/17 to 3/3/2018 E Auto-renewal: through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 3/4/2014 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201653
CONTRACT AMOUNT $0.00
ADDITIONAL INFO:
Contract#: A-14-084 State/Vendor#:
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:December 1, 2017
Renew contract through: , 20
With no changes in terms or conditions.
With the following change(s):
� lvergreen: Continue contract through: — 20 2
❑ Cancel contract effective: _, 20— —.
❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
�V
Approved by:
Program Supervisor/Staff Analyst: z:2 - Date: 7- 0 /
Division Manager: �< —- Date: `� - 7 - J
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-70 0
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C&TRACT STATUS FOA
DATE: March 01, 2017 RECEIVEpFRE`'
MAR 0,6 2017
DIVISION(S): Community Health "PARTMENTOFpUB(Lead Division listed first) CONVMcIlS SEC C H
CONTRACTOR: STATE: HHS Agency, Office of Statewide Health n ing and
Development
SERVICES: Request for Nonpublic Patient Level Data
CURRENT PERIOD: 3/4/16 to 3/3/2017 E Auto-renewal: C- through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 3/4/2014 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201653
CONTRACT AMOUNT: $0.00
ADDITIONAL INFO:
Contract#: A-14-084 State/Vendor#:
Lead Dept: DPH Other Dept(s):
Complete the information below and return'to DPH Contracts by:June 1, 2017
Renew contract through: , 20_
With no changes in terms or conditions.
With the following change(s):
P-Evergreen: Continue contract through: 20
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
gram Supervisor/Staff Analyst: Date:
\� ivi ion Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090
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CONTRACT STATUS FORMti� �
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DATE: September 01, 2016 RECEI ES��
DIVISION(S): Community Health CEP 0 2 2016
(Lead Division listed first)
DEPARTMENT OF PUBLIC HEALT
CONTRACTOR: STATE: HHS Agency, Office of Statewide Health ENWaili9gEeTW
Development OV
SERVICES: Request for Nonpublic Patient Level Data
CURRENT PERIOD: 3/4/16 to 3/3/17 E Auto-renewal: through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 3/4/2014 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201653
CONTRACT AMOUNT $0.00
ADDITIONAL INFO:
Contract#: A-14-084 State/Vendor M
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:December 1. 2016
,Renew contract through: -Zj , 20-1 /7
- 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: J
am upervisor/Staff Anal - Date:
�IDivision Manager: Date:
0
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090