HomeMy WebLinkAboutR 2017-504-E Health - Piedmont Health Services for reimbursement for WIC hemoglobin testing DocuSign Envelope ID:6559831A-34F6-4E7D-8F67-060E5EABC688
PHS/OCHD Memo of Agreement
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Piedmont Health Services Party/Vendor Contact Person: Ashley Brewer Contact Phone:
336-570-3739 Party/Vendor Address: PO Box 17179 City Chapel Hill State:NC Zip: 27516 Department: Health
Amount: $10.000 Purpose: Reimbursement for WIC Hemoglobin Testing Budget Code(s): 10414001-476020-
71403 Vendor# 27898 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No Contract Type:
(Check one) New ❑ Renewal ® Amendment ❑ Effective Date 7/1/17 Approved by Board Yes No
Agenda Date:
This agreement is approved as to tec 9aY`II 'll lld ; co tent:
era 9/8/2017
Department Director's Signature 5145A2CD945C40F... Date:
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficien • i,i at"e,standards,specifications,and requirements:
Riskk. Cartulfh 9/8/2017
Office of the Risk Management Office 7FDCF9176900498... Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
'�°' 9/8/2017
Office of the Chief Financial Officer 704E5-1-81 Arr44.09 Date:
Legal Services
This agreement is approved as t ecfbsigffdahtl sufficiency:
a tAIAL 441t, 1 SCb 9/8/2017
or
Office of the County Attorney L.070A4n525C11E4EB._. 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 Docusign contracts:
Office of the Clerk to the Board Date:
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