AHCA CONTRACT NO. FA972 MINOR MODIFICATION NO. 2

EX-10.4 4 ex104fa972minor2.htm MINOR MODIFICATION NO. 2 TO CONTRACT FA972 Ex104FA972Minor2

Exhibit 10.4

AHCA CONTRACT NO. FA972

MINOR MODIFICATION NO. 2

WELLCARE OF FLORIDA, INC.

D/B/A HEALTHEASE

8735 Henderson Road

Renaissance 2

Tampa, Florida 33634

AHCA Contract No. FA972, as entered into on the 30^th day of August 2012, is hereby revised as follows:


1.	Standard Contract, Section III, Item B., Contract Managers, sub-item 1, is hereby amended to now read as follows:


1.	The Agency’s Contract Manager’s contact information is as follows:

Tanya Hand

Agency for Health Care Administration

2727 Mahan Drive, MS #50

Tallahassee, FL 32308

(850) 412-4060

All other terms and conditions of the Contract shall remain unchanged.



WELLCARE OF FLORIDA, INC.		STATE OF FLORIDA, AGENCY FOR
D/B/A HEALTHEASE		HEALTH CARE ADMINISTRATION


/s/ Gregg MacDonald		/s/ Tanya Hand
Gregg MacDonald		Tanya Hand
State President		Contract Manager

DATE:	4-8-14	DATE:	4/9/14

		APPROVED


		/s/ David Rogers
		David Rogers
		Assistant Deputy Secretary for Medicaid
		Health Systems

		DATE:	4/9/14

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