Procurement Request.pdf
PDF 104 KB Posted
- Attached to
- Master Agreement AZ|CTR059352
- Contract number
- CTR059352
- Issued by
- Arizona
About this file
This document is a Procurement Request Form from the Arizona Department of Health Services (AZDHS), specifically from the EDC Bureau, requesting an Intergovernmental Agreement (IGA) with Valleywise Health for a PrEP Patient Navigation Services contract. The procurement request is identified with reference number FY22-1575 and was initiated by a program contact.
The proposed contract is for PrEP Navigation Services with an estimated annual amount of $148,866, funded through federal sources as a multi-year agreement. The contract does not have an existing contract number, and all PDS (Procurement Determination Statement) forms have not yet been signed. The procurement process is expected to take approximately 3-4 months and will involve Valleywise Health as the suggested supplier. The funding is confirmed as available, and the contract term is designated as a multi-year agreement.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| CTR059352 Contract amendment No. 2.pdf | ||
| CTR059352 Amendment 1.pdf | ||
| CTR059352 Price Sheet Amendment 1.pdf | ||
| Debarment 3.2023.pdf | ||
| IGA_CTR059352_Executed__1_.pdf | ||
| Initial Pricing.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
3/9/23, 9:33 AM Procurement Requests - Valleywise Health PrEP Patient Navigation...
https://sharepoint.hs.azdhs.gov/Procurement/Lists/Procurement Requests/Assigned Officers.aspx#InplviewHash998818c1-e77d-4947-a44c-6a651c99e490=WebPartID%3D%7B998818C1--E77D--4947… 1/3
Procurement Request Form Arizona Department of Health Services | 150 N. 18th Avenue | Phoenix, AZ 85007
Please provide the following information to assist in the timely and accurate completion of the services requested.
Notes
Title Valleywise Health PrEP Patient Navigation
Reference #
FY22 - 1575
Bureau
EDC
Contract/Agreement Type IGA - Intergovernmental Agreements are cooperative agreements with other public agencies, state and local units of government. (Allow approximately 3-4 months for completion, depends largely on County)
See a list of Procurement Thresholds and timelines
Description PrEP Navigation Services
Please ensure Scope of Work is attached to this request.
Existing Contract Number N/A
Requestor Ricardo Fernandez
Phone 6023643854
Estimated date needed https://drive.google.com/file/d/1qKobWLv-xadfXMROTQoQ_30keEUiRg6v/view https://sharepoint.hs.azdhs.gov/Procurement/Lists/Procurement Requests/Assigned Officers.aspx#InplviewHash998818c1-e77d-4947-a44c-6a651c99e490=WebPartID%3D%7B998818C1--E77D--4947… 2/3
If federal funds, are they for a sub-recipient
(6800/9111, ISA, IGA,
RFGA, etc.)?
2 CFR 200.332 Form
3/31/2022
Program contact Ricardo Fernandez
Program contact phone 6023643854
Other Participants
All PDS signed?
No
Please ensure all PDS forms are attached to this request. Click here for Procurement Forms.
Estimated annual amount 148,866
Funding Available?
Yes
Funding Type Federal
No
No
Select a contract Term Multi-year Agreement
Suggested suppliers Valleywise Health
Informational Notice
Email this request to the following individuals for informational purposes only https://sites.google.com/azdhs.gov/financialservices/procurement/forms https://sharepoint.hs.azdhs.gov/Procurement/Lists/Procurement Requests/Assigned Officers.aspx#InplviewHash998818c1-e77d-4947-a44c-6a651c99e490=WebPartID%3D%7B998818C1--E77D--4947… 3/3
File details come from the government source that posted it. Updated .