Master Blanket Purchase Order ADHS13-043918

Header Information
Purchase Order Number: ADHS13-043918 Release Number: 0 Short Description: ADHS Regional Behavioral Health Authority - GSA 6 (Maricopa County)
Status: 3PS - Sent Purchaser: Ana Shoshtarikj Receipt Method: Quantity
Fiscal Year: 2013 PO Type: Blanket Minor Status:
Organization: Arizona Department of Health Services
Department: DBHS - Division of Behavioral Health Services Location: BHS1I - Division of Behavioral Health Services - Phoenix - Compliance Type Code: Single-Agency
Alternate ID: Entered Date: 03/25/2013 12:01:12 PM Control Code:
Days ARO: 0 Retainage %: 0.00% Discount %: 0.00%
Print Dest Detail: If Different
Catalog ID: Release Type: Standard Release Pcard Enabled: No
Contact Instructions: Ana Shoshtarikj- 602-542-1047 ana.shoshtarikj@azdhs.gov Tax Rate: Actual Cost: $0.01
Master Blanket/Contract End Date (Maximum): 09/30/2018 11:59:59 PM
Project No.:
Special Purchase Types:
Commodity Reference Id:
PO External Doc Type:
Agency Attachments: Part Two (2) Solicitation Special Terms and Conditions.pdf Part Three (3) Uniform Terms and Conditions Amended.pdf Part Six (6) Attachments Amended ~1.docx Part Two (2) Solicitation Scope of Work Amended~2.pdf Part Two (2) Solicitation Exhibits Amended~7.pdf Evaluation Documentation.pdf Contract Award Determination and Documents~1.pdf ADHS13-00002257 Solicitation File Documents.zip ADHS13-00002257 Procurement File Documents.zip Mercy Maricopa Intergrated Care Offer.zip ADHS13-043918 FE Amendment No. 1.pdf MMIC COI GL Auto Eff 20140401.pdf MMIC COI DO EO Cyber Eff 20140401.pdf Performance Bond - ACE 2014-04-01 $20.0M.pdf Performance Bond - Argonaut 2014-04-01 $20.0M.pdf Performance Bond - Liberty 2014-04-01 $25.5M.pdf ADHS13-043918 FE Amendment No. 2.pdf ADHS13-043918 FE Amendment No. 3.pdf ADHS13-043918 FE Amendment No. 4.pdf MMIC_TransportationSanction_Final 03.16.16.pdf SanctionAmt_PA Data and Pharmacy Utilization Report_3.30.15.pdf ADHS13-043918 A7.pdf ADHS13-043918 A6.pdf COI - MMIC CGL Auto Exp 04.01.16.pdf COI - MMIC DO EO Cyber Exp 05.01.16.pdf ADHS13-043918 Amendment 10.pdf
Vendor Attachments:
Agency Attachment Forms:
Vendor Attachment Forms:
Primary Vendor Information & PO Terms
Vendor: 000030108 - Mercy Maricopa Integrated Care
Colleen Alexander
4350 E Cotton Center Blvd, Building D
Phoenix, AZ 85040
Email: mburfp@AETNA.com
Phone: (602)453-6027
FAX: (602)263-2098
Alt. Reference: Z0401
Payment Terms: Net 30 Shipping Method: Best Way
Shipping Terms: As Specified Freight Terms: Freight Allowed
PO Acknowledgements:
Document Notifications Acknowledged Date/Time
Purchase Order Emailed to mburfp@AETNA.com at 03/27/2013 09:06:45 AM
Change Order 1 Emailed to mburfp@AETNA.com at 02/06/2015 09:54:11 AM
Change Order 2 Emailed to mburfp@AETNA.com at 04/29/2015 11:46:56 AM
Change Order 3 Emailed to mburfp@AETNA.com at 05/04/2015 04:21:55 PM
Change Order 4 Emailed to mburfp@AETNA.com at 05/11/2015 12:49:57 PM
Change Order 5 Emailed to mburfp@AETNA.com at 10/13/2015 11:10:56 AM
Master Blanket/Contract Vendor Distributor List
Vendor ID Alternative ID Vendor Name Preferred Delivery Method Vendor Distributor Status
PZ000030108 Mercy Maricopa Integrated Care Email Active
Master Blanket/Contract Controls
Master Blanket/Contract Begin Date: 10/01/2013 Master Blanket/Contract End Date: 09/30/2016
Cooperative Purchasing Allowed: No
Organization Department Dollar Limit Dollars Spent to Date Minimum Order Amount
ADHS - Arizona Department of Health Services AGY - Agency Umbrella Master Control $0.00 $0.00 $0.00
Item Information   
Print Sequence # 1.0, Item # 1:   Capitation rates are set by the State. Exhibit 11 titled Capitation Rates provides the current Capitation Rates. Exhibit 8 titled Capitation Data provides the State's basis to determine the capitation rates. 3PS - Sent
Bid # / Bid Item #:  ADHS13-00002257 / 1
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
This item is narrative
Print Sequence # 2.0, Item # 2:   Offeror must follow the instructions provided and complete this item pricing accordingly to validate and meet the submission requirements. 3PS - Sent
NIGP Code: 952-08
   Behavioral Health: H008-00
Bid # / Bid Item #:  ADHS13-00002257 / 2 Quote # / Quote Item #:  000016770 / 2
Receipt Method Qty Unit Cost UOM Discount % Total Discount Amt. Tax Rate Tax Amount Total Cost
Quantity 1.0 $0.01 EA - Each 0.00 $0.00 $0.00 $0.01
Manufacturer: Brand: Model:
Make: Packaging:
Property Number:
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