CN-640000-CL057-A3.pdf

This document is Amendment #3 to a contract between the State of Florida, Department of Health (the Department) and Florida Woman Care, LLC (the Provider), with the contract number CL057. The amendment involves the Family Planning Sterilization Services Program and specifically relates to changes in the Specific Model Attachment I (PSMAI).

The amendment replaces the original Attachment I in its entirety with a revised version, with core directives and instructions remaining consistent with prior years. The changes are based on the 42 Code of Federal Regulations Part 59 and Title X guidelines. The amendment is effective from July 1st, 2023, or the date of final signature, whichever is later. The document is signed by Aaron Sudbury, MD, Medical Director of Florida Woman Care, LLC on September 8, 2023, and by Kim Kossler, Administrator for the Florida Department of Health on September 13, 2023. The provider's Federal ID Number is 26-0609255.