HomeMy WebLinkAbout32078AGREEMENT NO. 07-290-4
AMENDMENT IV 1
2 THIS AMENDMENT, hereinafter referred to as Amendment IV, is made and
3 entered into this 21 st day of_-'-A--'~'p~ri..,_l __ , 2015, by and between the COUNTY OF
4 FRESNO, a political subdivision of the State of California, hereinafter referred to as "COUNTY", and
5 each Provider listed in Attachment A, attached hereto and by this reference incorporated herein,
6 collectively hereinafter referred to as "PROVIDER(S)", and such additional PROVIDER(S) as may,
7 from time to time during the term of this Agreement, be added by COUNTY. Reference in this
8 Agreement to "party" or "parties" shall be understood to refer to COUNTY and each PROVIDER,
9 unless otherwise specified.
10 WHEREAS, the parties entered into that certain Agreement, identified as COUNTY
11 Agreement No. 07-290, effective July 10, 2007, Amendment I, No. 07-290-1, effective September 29,
12 2009, Amendment II, No. 07-290-2, effective December 10, 2013, and Amendment Ill, No. 07-290-3,
13 effective October 28, 2014 hereinafter referred to as the "Agreement"; and
14 WHEREAS, COUNTY is authorized through its Negotiated Net Amount (NNA) Drug
15 Medi-Cal Agreement with the State of California, hereinafter referred to as State, Department of
16 Health Care Services (DHCS), to subcontract for Drug Medi-Cal services in Fresno County; and
17 WHEREAS, PROVIDER(S) are certified by the State to provide services required by
18 COUNTY, pursuant to the terms and conditions ofthis Agreement; and
19 WHEREAS, the parties desire to amend the Agreement regarding changes as stated
2 0 below and restates the Agreement in its entirety; and
21 NOW, THEREFORE, in consideration of their mutual promises, covenants and
2 2 conditions, hereinafter set forth, the sufficiency of which is acknowledged, the parties agree as follows:
23 I. That Section Two (2) of the Agreement, entitled TERM and found on Page Two (2),
2 4 beginning on Line Fifteen ( 15), shall be deleted in its entirety and the following inserted in its place:
25 "2. TERM
2 6 This Agreement shall become effective July 10, 2007 and shall terminate on June
27 30,2010. This Agreement shall automatically be extended for six (6) additional twelve (12) month
2 8 periods, pending funding availability, upon the same terms and conditions herein set forth, unless
- 1 -COUNTY OF FRESNO
Fresno, CA
1 written notice of non-renewal is given by COUNTY or COUNTY's DBH Director or her designee not
2 later than thirty (30) days prior to the close of the current Agreement term."
3 2. COUNTY and PROVIDER(S) agree that this Amendment IV is sufficient to amend
4 Agreement #07-290, Amendment I #07-290-1, Amendment II #07-290-2 and Amendment III #07-290-
5 3, and that upon execution of this Amendment IV, the Agreement, Amendment I, Amendment II,
6 Amendment III and Amendment IV together shall be considered the Agreement.
7 3. The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
8 covenants, considerations and promises contained in the Agreement and not amended herein shall
9 remain in full force and affect. This Amendment IV shall become effective upon execution by all
10 parties.
11 Ill
12 Ill
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15 Ill
16 Ill
17 Ill
18 Ill
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2 0 Ill
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2 4 Ill
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2 6 Ill
2 7 Ill
28 Ill
-2 -COUNTY OF FRESNO
Fresno, CA
1 IN WITNESS WHEREOF, the parties hereto have executed this Amendment IV to Agreement#
2 07-290 as of the day and year first hereinabove written.
3 ATTEST:
4
5 COUNTY OF FRESNO
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By:~~~ua~~~~~~~v~~
DEBORAH A. POOCHIGIAN, CHAI
BOARD OF SUPERVISORS
Date: ~'1/,___JJ js--:--=----1 r_
BERNICE E. SEIDEL, CLERK
BOARD OF SUPERVISORS
By k~ ~sJoO'{J
~
Date: W ~l,c9-D!6
PROVIDER(S)
SEE ATTACHMENT A
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
The following is for COUNTY's Use:
Fund/Subclass: 0001/1 0000
Organization: 56302081
Account/Program: 7294/0
APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG, COUNTY COUNSEL
By:~~~~~~~~~~~~~
Date V----------------
APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-
CONTROlj~~~SURE~-TAX COLLECTOR
By: J{j~c. , ~
Date: ~/d./;s-1 I
REVIEWED AND RECOMMENDED FOR
APPROVAL:
By: lYo..Mt-a.___,.._ 7A:)-e--c~-:f-
DA WAN UTECHT, DIRECTOR
DEPARTMENT OF BEHAVIORAL HEALTH
Date:
-3 -
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COUNTY OF FRESNO
Fresno, CA
1 Provider: ADDIC D TREATMENT, INC.
2 By: ________ ~~~~~~~~--------
3 Print Name: JASO
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Title: PRESIDENT / ( _
Date: · 2-r 2() t 5 6 :By:~---
9 Print Name: ED BARISONE
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11 Title: EVP-FINANCE
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Date: --=2-~1 ?()::____:______+-( =2:.:_::_0~\ ~---==''---------
- 4 -COUNTY OF FRESNO ,
Fresno. CA
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Provider: AEGIS _.., .... '""" NT CENTERS, LLC.
By: ________ L_~~-------------------
Print Name: _ ___LA___l__·~~~==----------
Title: ------:-------' _(k-=--..!/.:::_o ________________ _
Chairman of Board, or President
Or any Vice President
Date: 3 }q//s
-----~~-----------
Title: I VI~ fbuJe ColNh u (
Secretary of Corporation, or
Any Assistant Secretary, or
ChiefFinancial Officer, or
Any Assistant Treasurer
Date: 3 / f iJ / ~ / 5'
-5 -COUNTY OF FRESNO
Fresno, CA
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ProVf~NIRAJi C~II«!RNIA RECOVERY, INC.
By: ~ ~ ~~--
Print Name: :Mle t..J&rre--
Title: ~~~ .
Chairman of Board, or President
Or any Vice President
Date: -----------------------------------
By: -----"~=~==-=--==-~-===-----IV~c!&-----.:....="""---'-----
Print Name: ~l}.~t-b/tA...d /J_ W~ ;·/e_
--Title: ___ g------=::e..c..A=_e..~l/t---'--'--'~=-------J'--------
Secretary of Corporat15ll, or
Any Assistant Secretary, or
ChiefFinancial Officer, or
Any Assistant Treasurer
Dme: ___ ~cJ=-~-L~f~-~~---------
- 6 -COUNTY OF FRESNO
Fresno, CA
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Provider: DELTA CARE, INC.
By: e~ ~
Print Name: -~------'-\__;T'--A,____ _ _,~=..:._,v---=-u..:....:(IV~v:>l\=----------
Title: Z.... >< !C. C<.....L 'T l v E:-D t (Q...E;-c..:T o(2._
Chairman of Board, or President
Or any Vice President
7 Date: _ ____:::_P----1\r-=-~---=~'--------l-\ _1 =5 ________ _
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By: \d()CL~ &tJ·l!VLf;,
Print Name: \-\--l A-GJ N ll+ A ~ I f'/ It-
Title: St-'--~~
Secretary of Corporation, or
Any Assistant Secretary, or
ChiefFinancial Officer, or
Any Assistant Treasurer
Date: (9~-2-~-\~
- 7 -COUNTY OF FRESNO
Fresno, CA
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Provider: EMINENCE HEALTHCARE, INC ..
By: ~/.L,~
Print Name: R-lt>ha~ct L. 77?to~~ta~1
e~o
Chairman ofBoard, or President
Or any Vice President
d..[ )K I~() I r:;
Title: (:TO
Secretary of Corporation, or
Any Assistant Secretary, or
Chief Financial Officer, or
Any Assistant Treasurer
Date: 2. ... 1 ·z......,-j l s-
- 8 -COUNTY OF FRESNO
Fresno, CA
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Provider: FRESNO COUNTY HISPANIC COMMISSION ON ALCOHOL & DRUG ABUSE
. SEI)VIC~S, INC.
By.vAA~ ~--
Print Name: ~GGtt:: dAYI+M()
Title: Bo4£Z.D-C\\A,t,12..
Chairman of Board, or President
Or any Vice President
By: __ ~~~·--
PrintName: _ _____,lJt.,..o!-~CJ~P·· 111~t''i?~9~o,_. --..(iZ ..... O(J~~-L...Ia4-.. ,_f-a~ .... --_
Title: &eG/1 /r~H! -Otwclat/
Secretary of Corporation, or
Any Assistant Secretary, or
ChiefFinancial Officer, or
Any Assistant Treasurer
nate: lelx. 2.1 i -?...0117/
- 9 -COUNTY OF FRESNO
Fresno, CA
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Provider: FRESNO NEW CONNECTIONS, INC.
By: ____ ~~~~~~~~~~~--------
Title: Pre-S/deaf
Title:
Date:
Chairman of Board, or President
Or any Vice President
Any Assistant Secretary, or
ChiefFinancial Officer, or
Any Assistant Treasurer
.~¢~.
-10 -COUNTY OF FRESNO
Fresno, CA
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Provider: GENERATIONAL CHANGES, INC.
By: . ~ --
Print Name: Linda Washington
Title: --=C~E~O ______________ _
Chairman of Board, or President
Or any Vice President
Title: Secretary
Date:
Secretary of Corporation, or
Any Assistant Secretary, or
ChiefFinancial Officer, or
Any Assistant Treasurer
J-.:J-~/~
-11 -COUNTY OF FRESNO
Fresno. CA
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Provi~·de ·KING OF KINGS ~OMMUNITY CENTER, INC. By:___!~~
P .·t Jesse~, Jr. nn rune: ------~· ____________________ __
Title: Chainoan of tbe Board
Chairman of Board, or President
Or any Vice President
By:~
Print Nrune: Willie Iewis
Title: Secretary of tbe Board
Secretary of Corporation, or
Any Assistant Secretary, or
Date:
Chief Financial Officer, or
Any Assistant Treasurer
-12 -COUNTY OF FRESNO
Fresno, CA
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::ovider~RATION
Print Name: L~ eoA.J He{)vt.J(_
Title: (},_f.O
Chairman of Board, or President
Or any Vice President
Print Name: CaYLd, ~ j Srvtrti >
J
Title: -~=-----.:....=~==:==.=~:::...__7)-=J==---=-w_---=--=-0-/o--'----Y __
Secretary of Corporation, or
Any Assistant Secretary, or
Chief Financial Officer, or
Any Assistant Treasurer
Date: _.8__,. ~,__11--,~-/----=;:..__o_-______ _ . ,.
-13 -COUNTY OF FRESNO
Fresno, CA
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Provider: MEDMARK TREATMENT CENTERS-FRESNO WEST, INC.
By:. c::=: \ > ~>.._ __ ~
Print Name: D~vfd /(_, \1\Jb i±P-
Title: __ 1l__!__· __LY!_::_~_::_SLlLld~W~----·-' ___ _
Chairman of Board, or President
Or any Vice President
By: ------~~~~-----------------
Print Name: J)ttvw·cz_ ( G-vcr~r\+t~
Title: ~Cd!..:.~~-*_L__-h~, 1/"--to/r-~e-c-=-=-' ?l-=--=-o_!_+~'----=:G=--2-_v_
Secretary of Corporation, or
Any Assistant Secretary, or
Chief Financial Officer, or
'Any Assistant Treasurer
16 Date: CJ-/d-5/dDrS ---~~~~~~~~------------------
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-14 -COUNTY OF FRESNO
Fresno, CA
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HEALTH SYSTEMS, INC.
By: ____ -7~~~----------------------
Print Name: KJ ifl\;f£11~ eQbd
Title: ('h:o ~ PYt1>\{iunt
Chairman of Board, or President
Or any Vice P esident
Secretary of Corporation, or
Any Assistant Secretary, or
ChiefFinancial Officer, or
Any Assistant Treasurer
Date: 1--j 2. ?J I "20 I'?
-15 -COUNTY OF FRESNO
Fresno, CA
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Provider: PANACEA SERVICES, INC. By.F< -~
PrintName: ~,·\\~? Co\o.Qt:~:f-
Title: cop, C""5 i.~ c.~\...
Chairman of Board, or President
Or any Vice President
7 Date: --------------~------------------
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Title: ~ c:: ,-<. f;.. ,_.....,
Secretary of Corporation, or
Any Assistant Secretary, or
ChiefFinancial Officer, or
Any Assistant Treasurer
Date: 2./ Z ¢..5 -
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-16 -COUNTY OF FRESNO
Fresno, CA
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Provider: :rROMESA BEHAVIORAL HEALTH
By:~~~
Print Name: Nt C/IA£ L a!C ~NOU r; L-
Title: J9<£S/D£"/v T.
.·· Chai~~ of Board, Or President .
Or any Vice President
Date: c:J.-a{) -,;/ 01.5 --
Title: _:.. ~~-~~~\\~e~(L=---------
Secretary of Corporation, or
Any Assistant Secretary, or
ChiefFinancial Officer, or
Any Assistant Treasurer
Date: d-\ d-0 \ 's
\ I
-17 -COUNTY OF FRESNO
Fresno, CA
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Title: C..£0 --==-------------------------------
Chairman of Board, or President
Or any Vice President
Date: ~~~~'---=-+~--=2_CJ--=--/-~-------
By: ------r7ff---f-P~--
Print Name: --=Sa~.L.O{ b:r-?j-+'<ee_.__..-t_~=~....,.._.__."cJ_/ __ ___
Title: __ ____:C!o...,L._~ .!--'fO~--------
Secretary of Corporation, or
Any Assistant Secretary, or
ChiefFinancial Officer, or
Any Assistant Treasurer
Date:
-18 -COUNTY OF FRESNO
Fresno, CA
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:;vi~:~~JtORNIA,INC.
PrintName:i) ~Jedd'Q)
Title: SR \JP
Chairman of Board, or President
Or any Vice President
Date: --l.Ld-----..!.Ld-----!:7_-..L...:j S~-------
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Pnnt Name: ~] l.J\ -\--\ A-t\J tv A
Title: Sea-ex a.~ ef ~A/&.lj)w eo,~
Secretary of C oration, or
Any Assistant Secretary, or
Chief Financial Officer, or
Any Assistant Treasurer
Date: f"E -!).I -a:-01"5
-19 -COUNTY OF FRESNO
Fresno, CA
Vendor
Addiction Research and
Treatment
Remit to:
1145 Market Street 10th Floor
San Francisco CA 94103
Aegis Medical Systems, Inc.
Remit to:
7246 Remit Ave.
Canoga Park CA 91303
Central California Recovery, Inc.
Remit to:
1100 W. Shaw Ave., #130
Fresno, CA 93711
Delta Care, Inc.
Remit to:
4705 N. Sonora Ave., Ste 113
Fresno CA 93722
Eminence Health Care, Inc.
Remit to:
7225 N. First St., Ste 101
Fresno CA 93720
Attachment A
DMC Vendor List
Phone Primary Site
(559) 498-7100 3103 E. Cartwright
Fresno CA 93725
(559) 268-6261 1235 E Street
Fresno CA 93706
(559 266-9581 539 N. Van Ness
Fresno CA 93728
Contracted for NRT
svcs.
(559) 229-9040 3707 E. Shields
Fresno CA 91303
Contracted for NRT s
svcs.
(559) 273-2942 1100 W. Shaw Ave., #130
Fresno CA 93711
(559) 276-7558 4705 N. Sonora Ave., Ste 113
Fresno CA 93711
(559) 221-8100 750 Van Ness Street
Coalinga CA 93210
2045 N. Dickerson Ave.
Fresno CA 93723
3535 N. Cornelia Ave.
Fresno CA 93722
1700 Anchor Ave.
Orange Cove, CA 93646
3125 Wright Street
Selma CA 93662
603 3rd Street
Page 1 of4
Satellite
10026 S. Crawford Ave.
Dinuba CA 93618
265 Cambridge
Coalinga CA 93210
1201 E. Parlier
Parlier, CA 93648
16875 4th Street
Huron CA 93234
4056 North Bryan
Fresno CA 93723
2270 Sylvia Street
Continued
Eminence Health Care, Inc.
Remit to:
7225 N. First, Ste. 101
Fresno CA 93720
Fresno County Hispanic
Commission Center
Remit to:
1803 Broadway Street
Fresno CA 93721
Fresno New Connections
Generational Change, Inc.
King of Kings Community Center,
Inc.
Remit to:
2302 Martin Luther King Jr. Blvd.
Fresno CA 93706
Kings View Corporation
Remit to:
1822 Jensen Avenue, #102
Sanger CA 93657
MedMark Treatment Centers,
Inc.
Remit to:
401 E. Corporate Drive, Ste 220
Lewisville TX 75057
Mental Health Systems
Remit to:
9465 Farnham Street
San Diego CA 92123
Attachment A
DMC Vendor list
Parlier CA 93648
(559) 221-8100 740 West North Ave.,
Reedley CA 93654
1045 Bethel Ave.
Sanger CA 93657
3160 w. Mt. Whitney Ave.
Riverdale CA 93656
6450 De Woody
Laton, CA 93242
(559) 268-6480 1803 Broadway Street
Fresno CA 93721
(559) 248-1548 4411 N. Cedar., Ste 108
Fresno CA 93726
(559) 681-0533 1313 P Street
Fresno CA 93721
(559) 442-0400 2302 Martin Luther King Jr.
Blvd.
Fresno CA 93706
(550) 875-6300 1822 Jensen Avenue, #102
Sanger CA 93657
(559) 264-2700 1310 M Street
Fresno CA 93721
(559) 264-7521 ext. 7 Fresno Center for Change
2550 W. Clinton, Bldg. A
Fresno CA 93705
Page 2 of4 ·
Selma CA 93662
33280 Lodge Road
Tollhouse CA 93667
900 Newmark Ave.
Parlier CA 93638
33326 Lodge Road
Tollhouse CA 93667
1239 E. Nelson Blvd.
Selma CA 93662
1111 N. Bond Ave.
Fresno CA 93726
830 Fresno Street
Fresno CA 93706
Continued
Mental Health Systems, Inc.
9465 Farnham Street
San Diego, CA 92123
Panacea
Remit to:
3152 N. Millbrook, Suite D
Fresno CA 93703
Promesa Behavioral Health, Inc.
Remit to:
7475 N. Palm Ave., #107
Fresno CA 93711
Prodigy Healthcare Inc.
Remit to:
P.O. Box820
Fowler CA 93625
Attachment A
DMC Vendor List
(550) 225-9117 Family and Youth Alternatives
3122 N. Millbrook Ave., Suites
A&B
Fresno CA 93703
(559) 241-0364 3152 N. Millbrook, Suite D
Fresno CA 93703
(559) 439-5437 7475 N. Palm Ave., #107
Fresno CA 93711
2910 & 2920 E. Olive Ave.
Fresno CA 93701
(559) 892-9452 1600 16th Street
Firebaugh, CA 93622
1976 Morris Kyle Drive
Firebaugh CA 93622
Page 3 of4
4928 E. Clinton Ave., #108
Fresno CA 93727
6425 W. Bowles
Raisin City, CA 93624
741 Tulare Street
Parlier CA 93648
900 Newmark Ave.
Parlier CA 93648
211 Smooth Ave.
Mendota CA 93640
241 Smooth Ave.
Mendota CA 93640
1258 E. Belmont
Mendota CA 936401
19191 Excelsior Ave.
Five Points CA 93624
6052 South Juanche Street
Tranquility CA 93668
1666 Saipan Ave.
Firebaugh CA 93622
658 Adams
Fowler CA 93625
West Care California Inc.
Remit to:
P.O. Box 12107
Fresno CA 93776
Attachment A
DMC Vendor List
701 East Main Street
Fowler CA 93625
(559) 443-4850 611 E. Belmont
Fresno CA 93701
Page 4 of4
701 E. Walters Ave.
Fowler CA 93625
1550 Herndon Ave.
Clovis CA 93611
2727 N. Cedar
Fresno CA 93703
13620 S. Kincaid
Caruthers CA 93776
818 L. Street
Sanger CA 93657
808 S. lOth Street
Fresno CA 93702