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 25758009972 | 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: laura.ortmeyer@oa.mo.gov Phone: (573)751-4579 Fax: (573)526-9817 |
SIGNATURE OF BUYER /s/ Laura Ortmeyer | DATE 6/27/08 |
DIRECTOR OF PURCHASING AND MATERIALS MANAGEMENT /s/ James Miluski |
DIVISION OP PURCHASING AND MATERIALS MANAGEMENT (DPMM)
CONTRACT' AMENDMENT
| AMENDMENT NO.: 009 Revised | RKQ NO.: NR SS6 25758009972 |
| 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:laura.ortmeyer@oa.mo.gov |
| 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
(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
Jefferson City MO 05102-6500
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 Tina.Gallagher@wellcare.com |
PHONE NUMBER (800) 608-8158 Ext. 2405 | FAX NUMBER (800) 608-8157 |
TAXPAYER ID NUMBER (TIN) 36-4050495 | 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 |
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.
