21._CCHCS-MC-332-_Contactor_Contact_Info.pdf
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- Attached to
- On-Site Dialysis Request for Proposal SD23-00097
- Solicitation number
- 0000032853
About this file
This document is a Contractor Contact Information form for a state contract opportunity issued by the California Correctional Health Care Services (CCHCS) for On-Site Dialysis Services. The contract opportunity has a proposal number of SD23-00097. The form requires the contractor to provide their company name, telephone number, fax number, name and title of an authorized representative, and the authorized representative's signature. The contractor must submit a separate form for each service type awarded. The completed form(s) must be submitted to the CCHCS Direct Care Contracts Section Help Desk.
The document does not provide any additional details about the pricing terms, set asides, incumbents, funding requirements, or other salient information related to the contract opportunity.
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Text version
Proposal Number: SD23-00097
Attachment 21
CCHCS-MC-332 – Contractor Contact Information Rev. 11/01/2017
CONTRACTOR CONTACT INFORMATION
The information provided below is included on the award matrix posted on the California Department of Corrections and Rehabilitation Internet website. This information is used by institutions/facilities to contact your company to request services. It is the contractor’s responsibility to submit a new form to California Correctional Health Care Services (CCHCS) if there are any changes to the telephone number and/or fax number provided below. If your company was awarded a contract for more than one service, then a separate form for each service type is required. Submit the completed form(s) to the CCHCS Direct Care Contracts Section Help Desk at: cchcshealthcarecontractshelpdesk@cdcr.ca.gov.
Type of Service: On-Site Dialysis Services
Company Name: (Must be identical to the payee’s legal business name listed on the STD 204)
Telephone Number: Fax Number:
Name of Authorized Representative: Title:
Signature of Authorized Representative: Date:
File details come from the government source that posted it. Updated .