Amendment number 9 to Missouri HealthNet Managed Care Eastern Region contract between the State of Missouri Office of Administration Division of Purchasing and Materials Management and Harmony Health Plan of Illinois, Inc. d/b/a Harmony Health Plan of Missouri

EX-10.2 3 moamendment9.htm MO MEDICAID CONTRACT AMENDMENT 9 moamendment9.htm

Back to Form 8-K

Exhibit 10.2

NOTICE OF AWARD

State Of Missouri

Office Of Administration

Division Of Purchasing And Materials Management

PO Hox 809

Jefferson City, MO 65102

http://www.oa.mo.gov/purch

CONTRACT NUMBER C306118005	CONTRACT TITLE Medicaid Managed Care-Eastern Region
AMENDMENT NUMBER Amendment #009 Revised	CONTRACT PERIOD July 1, 2007 through June 30, 2008
REQUISITION NUMBKH NR 886 ###-###-####	VENDOR NUMBER 3640504950 1
CONTRACTOR NAME AND ADDRESS HARMONY HEALTH PLAN INC 23 PUBLIC SQUARE STE 400 BELLEVILLE IL 62220	STATE AGENCY’S NAME AND ADDRESS Dept of Social Services MO HealthNet Division PO Box 6500 Jefferson City, MO 65102-6500
ACCEPTED BY T'HE STATE OF MISSOURI AS FOLLOWS: Contract C306118005 is hereby amended pursuant to the attached Amendment #009 Revised dated 06/25/08
BUYER Laura Ortmeyer	BUYER CONTACT INFORMATION Email: *@* Phone: (573 ###-###-#### Fax: (573 ###-###-####
SIGNATURE OF BUYER /s/ Laura Ortmeyer	DATE 6/27/08
DIRECTOR OF PURCHASING AND MATERIALS MANAGEMENT /s/ James Miluski

STATE OP MISSOURI

OFFICE OF ADMINISTRATION

DIVISION OP PURCHASING AND MATERIALS MANAGEMENT (DPMM)

CONTRACT' AMENDMENT

AMENDMENT NO.: 009 Revised	RKQ NO.: NR SS6 ###-###-####
CONTRACT NO.: C3061I8005	BUYER: Laura Ortmeyer
TITLE: MO Health Net Managed Care - Eastern Region	PHONE NO.: (573) 751-4579
ISSUE DATE: 06/11/08	E-MAIL: *@*

TO:	HARMONY HEALTH PLAN OF MISSOURI 23 PUBLIC SQUARE STE 400 BELLEVILLE IL 62220

RETURN AMENDMENT NO LATER THAN: 06/25/08 AT 5:00 PM CENTRAL TIME

RETURN AMENDMENT TO:

(U.S. Mail)	or	(Courier Service)
Div of Purchasing & Matls Mgt (DPMM) PO BOX 809 JEFFERSON CITY MO 65102-0809		Div of Purchasing & Matls Mgt (DPMM) 301 WEST HIGH STREET, ROOM 630 JEFFERSON CITY MO 65101-1517

OR FAX TO: (573) 526-9817 (either mail or fax, not both)

DELIVER SUPPLIES/SERVICES FOB (Free On Board) DESTINATION TO THE FOLLOWING ADDRESS:

Department of Social Services, MO HealthNet Division

Post Office Box 6500

Jefferson City MO 05102-6500

SIGNATURE REQUIRED

DOING BUSINESS AS (DBA) NAME Harmony Health Plan of Illinois, Inc., d/b/a Harmony Health Plan of Missouri	LEGAL NAME OF ENTITY/INDIVIDUAL FILED WITH IRS FOR THIS TAX ID NO. Harmony Health Plan of Illinois, Inc
MAILING ADDRESS 23 Public Square, Suite 400	IRS FORM 1099 MAILING ADDRESS 200 West Adams Street, Suite 800
CITY, STATE, ZIP CODE Belleville, IL 62220	CITY, STATE, ZIP CODE Chicago, IL 60606

CONTACT PERSON Ms. Tina Gallagher		EMAIL ADDRESS *@*
PHONE NUMBER (800) 608-8158 Ext. 2405		FAX NUMBER (800) 608-8157
TAXPAYER ID NUMBER (TIN) 36 ###-###-####	TAXPAYER ID (TIN) TYPE (Check One) þ FEIN SSN		VENDOR NUMBER (IF KNOWN) 3640504950 1
VENDOR TAX FILING TYPE WITH IRS (CHECK ONE) __Corporation __Individual __State/Local Government __Partnership __Sole Proprietor __Other ____________________
AUTHORIZED SIGNATURE /s/ Heath Schiesser		DATE 6/25/08
PRINTED NAME Heath Schiesser		TITLE President and CEO

Contract C306118005

AMENDMENT #009 Revised TO CONTRACT C306118005

CON TRACT TITLE: Mo Health Net Managed Care - Eastern Region

CONTRACT PERIOD: July 1, 2007 through June 30, 2008

The State of Missouri hereby desires to amend the above-referenced contract, as follows.

For the period April 1, 2008 through June 30, 2008, item 2.25.2 of the RFP portion of the contract shall be revised as follows:

2.25.2

The health plan shall transmit encounter- data and all required files in accordance with the Health Plan Record Layout Manual, as amended.

All other terms, conditions and provisions of the contract, including all prices, shall remain the same and apply hereto,

The contractor shall sign and return this document, on or before the date indicated, signifying acceptance of the amendment.