HomeMy WebLinkAboutA-19-212 DPH Misc. Docs.pdf OF co
CONTRACT STATUS FORM fo
O ss O
DATE: November 01, 2024 RECEIVED K
DIVISION(S): Emergency Services
DEC 0 2 202
(Lead Division listed first) TMENT Of PUB 10 �
DEPAR 0NjmcTS SE� N
CONTRACTOR: MASTER AGREEMENT: MOU Promslon of Medical Prophylaxis in a
Closed Point of Dispensing (CPOD)
SERVICES: Medical Prophylaxis in a Closed Point of Dispensing (CPOD)
CONTRACT TERM: 5/7/19 to 5/6/25 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201621
CONTRACT AMOUNT: $0.00
Contract#:A-19-212 StateNendor#:
Lead Dept: ,DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:February 1, 2025
Extend contract through: 120
With no changes in terms or conditions.
With the following change(s):
Evergreen: Continue contract through: S 20 Z Co
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
Program Supervisor/Staff alyst: Date:
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090
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CONTRACT STATUKtUtIVLU
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DATE: November 01, 2023 JAN 10 2024
DIVISION(S): Emergency Services D�ACONTRACTS SECTION AL H
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(Lead Division listed first)
CONTRACTOR: MASTER AGREEMENT: MOU Provision of Medical Prophylaxis in a
Closed Point of Dispensing (CPOD)
SERVICES: Medical Prophylaxis in a Closed Point of Dispensing (CPOD)
CONTRACT TERM: 5/7/19 to 5/6/24 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201621
CONTRACT AMOUNT: $0.00
Contract#: A-19-212 State/Vendor#:
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:February 1, 2024
Extend contract through: , 20
With no changes in terms or conditions.
❑ With the following change(s):
i
Evergreen: Continue contract through: , 20 2S
Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by: I �, �Z
Program Supervisor/S A ys Date: I
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
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CONTRACT STATUS FORM
RECEIVED toeg"It
DATE: November 01, 2022
NOV 2'1 2022
DIVISION(S): Emergency Medical Services DEPARTMENT OF PUBLIC HE
(Lead Division listed first) CONTRACTS SECTION
CONTRACTOR: MASTER AGREEMENT: MOU Provision of Medical Prop ylaxis in a
Closed Point of Dispensing (CPOD)
SERVICES: Medical Prophylaxis in a Closed Point of Dispensing (CPOD)
CONTRACT TERM: 5/7/19 to 5/6/23 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201621
CONTRACT AMOUNT: $0.00
Contract#: A-19-212 State/Vendor M
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:February 1, 2023
*Extend contract through:
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: e� �� ZZ
Program Supervisor/Staff yst: Date:
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
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CONTRACT STATUS F
60
DATE: November 01, 2021 NOV 0 S 2021 0� FuES
DIVISION(S): Emergency Medical Services DEPARTMENT OF PUBLIC H LT
(Lead Division listed first) CONTRACTS
CONTRACTOR: MASTER AGREEMENT: MOU Provision of Medical POphylaxis in a
Closed Point of Dispensing (CPOD)
SERVICES: Medical Prophylaxis in a Closed Point of Dispensing (CPOD)
CONTRACT TERM: 5/7/19 to 5/6/22 E
ADDITIONAL INFO: Evergreen Agreement-Please Review
ORGANIZATION #(s): 56201621
CONTRACT AMOUNT: $0.00
Contract#: A-19-212 State/Vendor#:
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:February 1. 2022
Extend contract through: 120
❑ With no changes in terms or conditions.
❑ With the following change(s):
Evergreen: Continue contract through: /(O 20 Z3
❑ Cancel contract effective: , 20
❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by.
Program Supervisor/S lyst: Date:
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
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CONTRACT STATUS FORM
RECEIVED `u
O� 56 O
DATE: November 02, 2020 MAR 12 2021 s�
DIVISION(S): Emergency Medical Services DEPARTMENT OF PUBLIC HEAL
(Lead Division listed first) CONTRACTS SECTION
CONTRACTOR: MASTER AGREEMENT: MOU Provision of Medical Prop ylaxis in a
Closed Point of Dispensing (CPOD)
SERVICES: Medical Prophylaxis in a Closed Point of Dispensing (CPOD)
CURRENT PERIOD: 5/7/19 to 5/6/21 E
ENTIRE TERM: 5/7/2019 to Evergreen
ORGANIZATION #(s): 56201621
CONTRACT AMOUNT: $0.00
ADDITIONAL INFO: Evergreen Agreement-Please Review
Contract#: A-19-212 StateNendor#:
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:February 1, 2021
Extend contract through: , 20
With no changes in terms or conditions.
With the following change(s):
Evergreen: Continue contract through: x5/(' , 20 ,
❑ Cancel contract effective: , 20
Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Supervisor/Staff Analyst: Date: 3/Id/
Division Manager: Date:
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor - Phone #: 600-7090
co
CgwNTRACT STATUS FO%&d
HECEIVED 0
O� 56 O
DATE: September 03, 2019 SEP 10 2 1 `5
DIVISION(S): Emergency Medical Services DEPARTMENT OF PUBLIC E LTH
(Lead Division listed first) CONTRACTS SECTIO
CONTRACTOR: Master Agreement: MOU Provision of Medical Prophylaxis in a Closed
Point of Dispensing (CPOD)
SERVICES: Medical Prophylaxis in a Closed Point of Dispensing (CPOD)
CURRENT PERIOD: 5/7/19 to 5/6/20 E Auto-renewal: ❑ through:
(If not checkmarked above,contract will terminate
ENTIRE TERM: 5/7/2019 to Evergreen at the end of the current period.)
ORGANIZATION #(s): 56201621
CONTRACT AMOUNT: $0.00
ADDITIONAL INFO: Evergreen Agreement-Please Review
Contract#: A-19-212 State/Vendor#:
Lead Dept: DPH Other Dept(s):
Complete the information below and return to DPH Contracts by:December 1, 2019
❑ Renew contract through: , 20.
With no changes in terms or conditions.
With the following change(s):
Evergreen: Continue contract through: l��n Ii , 20
Cancel contract effective: , 20
❑ Additional Information (e.g., anticipated effective date/term, contract extension, etc.):
Approved by:
Program Supervisor/St An Date: 11,
Division Manager: Date: l�
Submit to: DPH Contracts - Stop #147 - Brix Building, 6th Floor- Phone #: 600-7090