My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
Agenda - 4-4-16 Reg. Meeting
public access
>
Clerk
>
AGENDA PACKAGES
>
2016
>
Agenda - 4-4-16 Reg. Meeting
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/30/2016 8:14:20 AM
Creation date
3/30/2016 8:12:08 AM
Metadata
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
128
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
Division of Public Health <br />Agreement Addendum <br />FY 15-16 <br />Page 1 of 1 <br />Lee County Health Department Epidemiology / Communicable Disease Branch <br />Local Health Department Legal Name DPH Section/Branch Name <br />Vivian Mears 252-341-3487 <br />610 STD Prevention vivian.mears@dhhs.nc.gov <br />Activity Number and Description DPH Program Contact <br />(name, telephone number with area code, and email) <br />06/01/2015 — 05/31/2016 <br />Service Period DPH Program Signature Date <br />(only required for a ne otQ iable agreement addendum) <br />07/01/2015 — 06/30/2016 <br />Payment Period <br />❑ Original Agreement Addendum <br />® Agreement Addendum Revision # 2 (Please do not put the Budgetary Estimate revision # here.) <br />I. Backiround: <br />AAR,-, No change. <br />II. Purpose: <br />This Agreement Addendum Revision #2 provides STD prevention funds. Receipt of these funds is the <br />primary mechanism recognized by Health Resources and Services Administration (HRSA)'s Office of <br />Pharmacy Affairs (OPA) as the basis for eligibility to be a covered entity for the STD 340b program. <br />III. Scope of Work and Deliverables: <br />As of March 1, 2016, this Agreement Addendum Revision #2 adds Paragraph 7 as follows: <br />7. Provide to the DPH Program Contact documentation which indicates that the Local Health <br />Department is an eligible organization through the federal 340B Program. <br />IV. Performance Measures/Reyortin2 Requirements: <br />No change. <br />V. Performance Monitoring and Ouality Assurance: <br />No change. <br />VI. Funding Guidelines or Restrictions: (if applicable) <br />No change. <br />Health Director Signature (use blue ink) <br />Local Health Department to complete: LHD program contact name: <br />(If follow up information is needed by DPH) Phone number with area code: <br />Email address: <br />Date <br />o.auuture on tors Page sigmnes you have read and accepted all Pages of this document <br />Revised July 2014 <br />
The URL can be used to link to this page
Your browser does not support the video tag.