ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION DIVISION OF BUSINESS AND FINANCE SECTION A: CONTRACT

1. AMENDMENT NUMBER:
    4

2.  CONTRACT NO.:
     YH09-0001-07

3.  EFFECTIVE DATE OF AMENDMENT:
     August 1, 2009

4.  PROGRAM:
     DHCM - ACUTE

5. CONTRACTOR/PROVIDER NAME AND ADDRESS:

VHS Phoenix Health Plan, LLC
7878 N. 16^th Street, Suite 105
Phoenix, Arizona  85020

6. PURPOSE OF AMENDMENT:  To amend Section B, Capitation Rates, effective October 1, 2008 and May 1, 2009.

7.

THE CONTRACT REFERENCED ABOVE FOLLOWS

To amend Section B, Capitation Rates, effective October 1, 2008 and May 1, 2009.

NOTE:  Please sign and date all copies and then return one executed original to:                    Mark Held
                                                                                                                                Sr. Procurement Specialist
                                                                                                                                AHCCS Contracts
                                                                                                                                701 E. Jefferson St., MD 5700
                                                                                                                                Phoenix, AZ  85034

8.  EXCEPT AS PROVIDED FOR HEREIN, ALL TERMS AND CONDITIONS OF THE ORIGINAL CONTRACT NOT HERETOFORE CHANGED AND/OR AMENDED REMAIN UNCHANGED AND IN FULL EFFECT.

IN WITNESS WHEREOF THE PARTIES HERETO SIGN THEIR NAMES IN AGREEMENT

9.  SIGNATURE OF AUTHORIZED REPRESENTATIVE:

10.  SIGNATURE OF AHCCCSA CONTRACTING OFFICER:

     /a/ Nancy Novick

       /s/ Michael Veit

TYPED NAME:      NANCY NOVICK

MICHAEL VEIT

TITLE:                    CHIEF EXECUTIVE OFFICER

CONTRACTS & PURCHASING ADMINISTRATOR

DATE: 7/7/09

DATE: JUL 02 2009