EXHIBIT 10.21
(AHCCCS LOGO)
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION
DIVISION OF BUSINESS AND FINANCE
SECTION A. CONTRACT AMENDMENT
- --------------------------------------------------------------------------------
1. AMENDMENT 2. CONTRACT 3. EFFECTIVE DATE 4. PROGRAM:
NUMBER: NO.: OF AMENDMENT:
19 YH8-0001-05 OCTOBER 1, 2002 OMC
- --------------------------------------------------------------------------------
5. CONTRACTOR'S NAME AND ADDRESS:
HEALTH CHOICE ARIZONA
1600 W. BROADWAY, SUITE 260
TEMPE, AZ 85282
- --------------------------------------------------------------------------------
6. PURPOSE OF AMENDMENT: TO EXTEND THE TERM OF THE CONTRACT FOR ONE YEAR AND
TO AMEND SECTIONS B, C, D AND E AND ATTACHMENTS B, F, H AND I.
- --------------------------------------------------------------------------------
7. THE CONTRACT REFERENCED ABOVE IS AMENDED AS FOLLOWS:
A. EXTENSION OF CONTRACT: In accordance with Section D, Paragraph 50, Term of
Contract and Option to Renew, this contract is extended for the period
10/1/02 - 9/30/03. The Contractor's response affirming or declining the
extension must be received by AHCCCSA no later than 3:00 PM, September 20,
2002.
B. CHANGES IN REQUIREMENTS: In accordance with Section E, Paragraph 30,
"Changes", various changes in contract requirements are indicated in this
contract restatement.
C. By signing this contract amendment, the Contractor is (1) agreeing to
perform for an additional year according to the terms of the contract as
amended, and (2) agreeing to the new and changed requirements contained
herein.
NOTE: PLEASE SIGN AND DATE BOTH AND THEN RETURN ONE TO:
MICHAEL VEIT, MD 5700
AHCCCS CONTRACTS AND PURCHASING
701 E JEFFERSON STREET
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 10. SIGNATURE OF AHCCCSA CONTRACTING
REPRESENTATIVE: OFFICER:
/S/ CAROLYN ROSE /S/ MICHAEL VEIT
- --------------------------------------------------------------------------------
TYPED NAME:
CAROLYN ROSE MICHAEL VEIT
- --------------------------------------------------------------------------------
TITLE: CONTRACTS & PURCHASING
CHIEF EXECUTIVE OFFICER ADMINISTRATOR
- --------------------------------------------------------------------------------
DATE: 9/20/02 DATE: AUG. 28, 2002
- --------------------------------------------------------------------------------