HomeMy WebLinkAboutR 2018-564 DSS - UNC Hospital medicaid processing DocuSign Envelope ID:57E2C492-6A9C-4912-l33A2-0E01 EDD5857C
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: UNCH PartyNendor Contact Person: Danielle Reese Contact Phone: (984) 974-
2779 Party/Vendor Address: 800 Eastowne Drive,Suite 200. City Chapel Hill State: NC Zip:27514 Department:
Social Services Amount: $41,021 Purpose: Medicaid Processing at UNCH Budget Code(s): 10403005-442311
Vendor#NA (N/A if new vendor) Vendor is a BOCC consultant? Yes❑ NoE Contract Type: (Check one)
New❑ RenewaI ® Amendment ❑ Effective Date July 1.2018 Approved by Board Yes❑NloZ Agenda
Date:
This agreement is approved as to to oocusigned by: tent:
N �,bS m& 9/12/2018
Department Director's Signature oAE9E1s6A83B455... Date:
Information Technologies
(Applicable only to hardwarelsofhvare 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 sufficient 'W* cuSigned by:' .ds,specifications,and requirements:
,USX ( Q�6 8/10/2018
Office of the Risk Management Officer Date:
- 7F6CF917E80Q498...
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
Office of the Chief Financial Officer 4 ns... _Date: 9/12/2018
7NE5181ACC14 —
Legal Services
This agreement is approved as t C OocuSigned by: i7Cy:
Office of the County Attorney � ' - Date: 9/13/2018
4035C68304CA4M... - -
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion Dolloyd@orangecountync.goy
The following signature block is for hard copies only and is not required for Docusign contracts: