HomeMy WebLinkAboutR 2019-842 Health - Walgreens drug dispense ORANGE COUNTY-DEPARTMENT USE ONLY C 1 ?
Party/Vendor Name : Walgreens Party/Vendor Contact Person . Christopher Sutter Contact Phone : 847 - 612 -0296
Party/Vendor Address : 104 Wilmot Road, MS4446 City Deerfield State : IL Zip : 60015 Department : Health
Amount : $ 10 , 000 Purpose : Manage and dispense OCHD ' s 340B drugs . Budget Code (s) : 10414020 - 630000 -
71406/71416/71418 Vendor # _ IA' (N/A if new vendor) Vendor is a BOCC consultant? Yes El No ®
Contract Type : (Check one) Ne ® Renewal ❑ Amendment ❑ Effective Date 1 - 1 -2020 Approved by Board
Yes ❑ No ❑ Agenda Date :
lY
This agreement is approved as to technical form and content and I as Department Director affirmatively state work
on this project has not been initiated prior to execution of the agreement :
Department Director ' s Signature 4Date :
Agreements for emergency services or pair are not subject to the above affirmation . If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that
was addressed :
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 sufficiency of insurance standards , specifications , and requirements :
Office of the Risk Management Officer Date : V /
Financial Services
This instrument has been pre - audited i4thennellrequjired y the Local Government Budget and Fiscal Control
Act :
Office of the Chief Financial Officer Date : j
Legal Services
This agreement is approved as to legal f an su cie
Office of the County Attorney Date :
Clerk to the Board
Received for record retention :
All Docusign contracts must be copied to Sherri Ingersoll upon completion : smgersoll@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 :
Revised 12/ 18