Agenda - 4-4-16 Reg. Meeting - Laserfiche WebLink

Home Browse Search

Division of Public Health Agreement Addendum FY 15-16 Page 1 of 1 Lee County Health Department Epidemiology / Communicable Disease Branch Local Health Department Legal Name DPH Section/Branch Name Vivian Mears 252-341-3487 610 STD Prevention vivian.mears@dhhs.nc.gov Activity Number and Description DPH Program Contact (name, telephone number with area code, and email) 06/01/2015 — 05/31/2016 Service Period DPH Program Signature Date (only required for a ne otQ iable agreement addendum) 07/01/2015 — 06/30/2016 Payment Period ❑ Original Agreement Addendum ® Agreement Addendum Revision # 2 (Please do not put the Budgetary Estimate revision # here.) I. Backiround: AAR,-, No change. II. Purpose: This Agreement Addendum Revision #2 provides STD prevention funds. Receipt of these funds is the primary mechanism recognized by Health Resources and Services Administration (HRSA)'s Office of Pharmacy Affairs (OPA) as the basis for eligibility to be a covered entity for the STD 340b program. III. Scope of Work and Deliverables: As of March 1, 2016, this Agreement Addendum Revision #2 adds Paragraph 7 as follows: 7. Provide to the DPH Program Contact documentation which indicates that the Local Health Department is an eligible organization through the federal 340B Program. IV. Performance Measures/Reyortin2 Requirements: No change. V. Performance Monitoring and Ouality Assurance: No change. VI. Funding Guidelines or Restrictions: (if applicable) No change. Health Director Signature (use blue ink) Local Health Department to complete: LHD program contact name: (If follow up information is needed by DPH) Phone number with area code: Email address: Date o.auuture on tors Page sigmnes you have read and accepted all Pages of this document Revised July 2014