EXHIBIT 10.35
ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION
DIVISION OF BUSINESS AND FINANCE
CONTRACT AMENDMENT
Page 1
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1. AMENDMENT NO.: 2. CONTRACT NO.: 3. EFFECTIVE DATE OF AMENDMENT: 5. PROGRAM:
08 YH04-0001-03 October 1, 2004 DHCM-ACUTE
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5. CONTRACTOR/PROVIDER NAME AND ADDRESS:
Health Choice Arizona
1600 W. Broadway, Suite 260
Tempe, Arizona 85282-1136
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6. PURPOSE:
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7. The above referenced contract is hereby amended as follows:
A. CHANGES IN REQUIREMENTS: In accordance with Section E,
Paragraph 30, "Changes", various changes in contract requirements
are indicated in this contract amendment.
B. By signing this contract amendment, the Contractor is
agreeing to the terms of the contract as amended.
NOTE: Please sign, date and
return both originals to: Gary L. Callahn, Contract Management Supervisor
AHCCCS Contracts and Purchasing
701 E. Jefferson, MD 5700
Phoenix, AZ 85034
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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.
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9. NAME OF CONTRACTOR: 10. ARIZONA HEALTH CARE COST
HEALTH CHOICE ARIZONA CONTAINMENT SYSTEM
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SIGNATURE OF AUTHORIZED INDIVIDUAL: SIGNATURE:
/s/ Carolyn Rose /s/ Michael Veit
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TYPED NAME: TYPED NAME:
CAROLYN ROSE MICHAEL VEIT
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TITLE: TITLE:
CHIEF EXECUTIVE OFFICER CONTRACTS AND PURCHASING ADMINISTRATOR
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DATE DATE:
8/12/04 SEP-9-2004
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