CTR053476 A4 fully executed.pdf

PDF 451 KB Posted Jul 1, 2021

Attached to: Master Agreement AZ|CTR053476
Contract number: CTR053476
Issued by: Arizona

About this file

Written by GovTribe AI · Oct 9, 2025

This document is a Contract Amendment (Amendment No. 4) issued by the Arizona Department of Health Services, Office of Procurement, for a High Risk Perinatal Program (HRPP) Emergency Ground Transportation Services contract with Flagstaff Medical Center. The contract number is CTR053476, and the amendment extends the contract through June 30, 2026, which represents the maximum five-year contract extension as specified in the Special Terms and Conditions.

The amendment pertains to ground transportation services for a high-risk perinatal program, with Flagstaff Medical Center serving as the contractor. The contract was signed by Robert Cofield, Chief Operating Officer of Flagstaff Medical Center, with a contractor signature date of April 19, 2025. The amendment maintains all previous provisions of the contract, with the sole modification being the extension of the contract term. Additional documentation included provides supplementary information about Flagstaff Medical Center, including its entity registration details, corporate status as a non-profit healthcare organization, and active registration with various government systems.

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Other files

File	Type	Posted
CTR053476_Pricing.pdf	PDF	Jul 1, 2021
CTR053480 Endorsement.pdf	PDF	Jul 1, 2021
Procurement Requests - Assigned Officers.pdf	PDF	Jul 1, 2021
2024.01.01 COI (2).pdf	PDF	Jul 1, 2021
2024_03_01 COI.pdf	PDF	Jul 1, 2021
3.5.21 CI HRPP executed.pdf	PDF	Jul 1, 2021
9.22.2021 CTR053476 CI HRPP for Flagstaff Medical Center executed.pdf	PDF	Jul 1, 2021
2023.03.01 COI.PDF	PDF	Jul 1, 2021
2025.01.01 COI WC (1).pdf	PDF	Jul 1, 2021
2025.03.01 COI GL PL AL.pdf	PDF	Jul 1, 2021
2026.03.01 COI GL PL AL.pdf	PDF	Jul 1, 2021
2022.07.01 COI'.pdf	PDF	Jul 1, 2021
2026_01_01 COI WC.pdf	PDF	Jul 1, 2021
2026_01_01_COI_WC.pdf	PDF	Jul 1, 2021
CTR053476 A3 Executed PDF.pdf	PDF	Jul 1, 2021
CTR053476 Amendment 2 executed With Debarment.pdf	PDF	Jul 1, 2021
CTR053476_Contract_Amendment_Summary_1.pdf	PDF	Jul 1, 2021
CTR053476_Final_Contract_Flagstaff_Medical_Center_executed.pdf	PDF	Jul 1, 2021
CTR053480 COI 7.1.2022.pdf	PDF	Jul 1, 2021
HRPP_CI_Determination_6.26.23_executed (1) (1).pdf	PDF	Jul 1, 2021

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Gina Corwin

Digitally signed by Gina Corwin Date:

2025.04.28 10:21:27 -07'00'

FLAGSTAFF MEDICAL CENTER

Unique Entity ID

L8RYDHRHBPW1

CAGE / NCAGE

0Z4N7

Purpose of Registration All Awards

Registration Status Active Registration

Expiration Date Mar 21, 2026

Physical Address 1200 N Beaver ST Flagstaff, Arizona 86001-3118 United States

Mailing Address 1200 N Beaver ST Flagstaff, Arizona 86001-3118 United States

Business Information

Doing Business as (blank)

Division Name (blank)

Division Number (blank)

Congressional District Arizona 02

State / Country of Incorporation Arizona / United States

URL

www.nahealth.com

Registration Dates

Activation Date Mar 25, 2025

Submission Date Mar 21, 2025

Initial Registration Date Feb 24, 2006

Entity Dates

Entity Start Date Mar 18, 1984

Fiscal Year End Close Date Jun 30

Immediate Owner

CAGE

4CB68

Legal Business Name

NORTHERN ARIZONA HEALTHCARE

CORPORATION

Highest Level Owner

CAGE

(blank)

Legal Business Name (blank)

Executive Compensation

Registrants in the System for Award Management (SAM) respond to the Executive Compensation questions in accordance with Section 6202 of P.L. 110-252, amending the Federal Funding Accountability and Transparency Act (P.L. 109-282). This information is not displayed in SAM. It is sent to USAspending.gov for display in association with an eligible award. Maintaining an active registration in SAM demonstrates the registrant responded to the questions.

Proceedings Questions

Registrants in the System for Award Management (SAM.gov) respond to proceedings questions in accordance with FAR 52.209-7, FAR 52.209-9, or 2. C.F.R. 200 Appendix XII. Their responses are displayed in the responsibility/qualification section of SAM.gov. Maintaining an active registration in SAM.gov demonstrates the registrant responded to the proceedings questions.

Exclusion Summary

Active Exclusions Records?

SAM Search Authorization

I authorize my entity's non-sensitive information to be displayed in SAM public search results:

Yes

Entity Types

Business Types

Entity Structure Corporate Entity (Tax Exempt)

Entity Type Business or Organization

Organization Factors (blank)

Profit Structure Non-Profit Organization

Last updated by Merle McCabe on Mar 21, 2025 at 01:29 PM FLAGSTAFF MEDICAL CENTER

Apr 28, 2025 06:43:53 PM GMT https://sam.gov/entity/L8RYDHRHBPW1/coreData?status=null Page 1 of 3

Socio-Economic Types

Check the registrant's Reps & Certs, if present, under FAR 52.212-3 or FAR 52.219-1 to determine if the entity is an SBA-certified HUBZone small business concern. Additional small business information may be found in the SBA's Dynamic Small Business Search if the entity completed the SBA supplemental pages during registration.

Other Entity Qualifiers

Hospital

Financial Information

Accepts Credit Card Payments Yes

Debt Subject To Offset No

EFT Indicator

CAGE Code 0Z4N7

Points of Contact

Electronic Business

Merle McCabe, Staff Accountant 1200 N Beaver ST Flagstaff, Arizona 86001 United States

Scott Ray, Controller 1200 N Beaver ST Flagstaff, Arizona 86001 United States

Government Business

Merle McCabe, Staff Accountant 1200 N Beaver ST Flagstaff, Arizona 86001 United States

Scott Ray, Controller 1200 N Beaver ST Flagstaff, Arizona 86001 United States

Past Performance

Harley Gossman, Accountant 1200 N Beaver ST Flagstaff, Arizona 86001 United States

Willie Felts, Corporate Controller 1200 N Beaver ST Flagstaff, Arizona 86001 United States

Service Classifications

NAICS Codes

Primary Yes

NAICS Codes 622110

NAICS Title General Medical And Surgical Hospitals

Product and Service Codes

PSC PSC Name

M1DA Operation Of Hospitals And Infirmaries

M1DZ Operation Of Other Hospital Buildings

X1DZ Lease/Rental Of Other Hospital Buildings

Z1DA Maintenance Of Hospitals And Infirmaries

Z1DZ Maintenance Of Other Hospital Buildings

Disaster Response

Yes, this entity appears in the disaster response registry.

Bonding Levels Dollars

Last updated by Merle McCabe on Mar 21, 2025 at 01:29 PM FLAGSTAFF MEDICAL CENTER https://sam.gov/entity/L8RYDHRHBPW1/coreData?status=null Page 2 of 3

(blank) (blank)

States Arizona

Counties AZ: Yavapai, Coconino

Metropolitan Statistical Areas AZ: Phoenix-Mesa, Flagstaff, AZ-UT

Last updated by Merle McCabe on Mar 21, 2025 at 01:29 PM FLAGSTAFF MEDICAL CENTER https://sam.gov/entity/L8RYDHRHBPW1/coreData?status=null Page 3 of 3

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CTR053476 A4 fully executed

Entity Data Detailed Results

Arizona Corporation Commission

OIG Search Results

File details come from the government source that posted it. Updated Oct 9, 2025.