HomeMy WebLinkAboutR 2017-343-E DSS - UNC Hospitals for medicaid processing DocuSign Envelope ID:2F1423ED-2589-479B-8D17-D6259D2980B6
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: UNCH Yurty/Youdor Contact Person: Margaret Dudley Contact Phone: (919) 974'
0935 Party/Vendor Address: 101 Manning Dr. City Chapel Hill State: NC Zip: 37514 Department: Social
Services Amount: $36974 Purpose: Medicaid Processing at UNCH Budget Code(s): 10403005'442311 Vendor#
NA (N/A if new vendor) Vendor is a BOCC consultant? Yes 0 }VoZ Contract Type: ` eukone) New 111 l
Renewal M Amendment 0 E�echveD�eJuly 1, 2017 Approved by Board you� NoM Agenda Date: �
This agreement is approved as to content: 1
7/25/2017
Department D�mctv�a8�omb^rd~--DAE,s,y6Ao313+55 Dam:
Information Technologies
(Applicable only/o6m'dwm'u6oft''mx purchases m/'related services)This agreement has been reviewed and h
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
|
This agreement is approved for sufficie durdx, specifications,and requirements:
| ^ ~'^' «`' `~~`` 7/10/2017
Office uf the Risk Management Ofbccr\^_*omy//o80v490 Date:
Financial Services �
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
7/25/2017
Office of the��biofFinancial Officer i ` «~ Date:
�~~,o^e5113 tfcem4199-
Legal Services
This agreement is approved as sufficiency:
$�u� 7/25/2017
Office of the County Attorney\._4o`,oao3om^4Ao Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusi u contracts: