Exhibit 10.23

     

   
   

     

   
  
    
       

      

      

      
      THIS AMENDMENT TO THE CONTRACT BETWEEN ADMINISTRACION DE SEGUROS DE SALUD DE PUERTO RICO (ASES) AND TRIPLE-S SALUD, INC., FOR THE PROVISION OF PHYSICAL AND BEHAVIORAL
        HEALTH SERVICES UNDER THE GOVERNMENT HEALTH PLAN (the "Amendment") is by and between Triple-S Salud, Inc. ("the Contractor"), a managed care organization duly organized and
        authorized to do business under the laws of the Commonwealth of Puerto Rico, with employer identification number 66-0555677 and represented by its President, Madeline Hernandez Urquiza, of legal age, single, resident of San Juan, Puerto Rico, and
        the Puerto Rico Health Insurance Administration (Administración de Seguros de Salud de Puetto Rico, hereinafter referred to as "ASES" or "the Administration"), a public corporation of the Commonwealth of Puerto Rico,
        with employer identification number 66-0500678, represented by its Executive Director, Jorge E. Galva Rodriguez, JD, MHA, of legal age, married and resident of Vega Alta, Puerto Rico.

       

      WHEREAS, the Contractor and ASES executed a
          Contract for the provision of Physical Health and Behavioral Health Services under the Government Health Plan for the Commonwealth of Puerto Rico, on September 21, 2018, (hereinafter referred to as the "Contract");

      

      

      WHEREAS, the Contract provides, pursuant to
          Article 55, that the Parties may amend such Contract by mutual written consent;

      

      

      WHEREAS, all provisions of the Contract will
          remain in full force and effect as described therein; except as otherwise provided in this Amendment.

      

      

      NOW, THEREFORE, and in consideration of the
          mutual promises herein contained and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree to clarify and/or amend the Contract as follows:

       

      	I.	
              AMENDMENTS

            


       

        	

              	1.	
                Attachment 11 of the Contract shall be amended to extend the coverage period until May 31, 2020, with no other changes made to this attachment:

              


         

        

      

      
        

      

       

        

      
        
          


      

      
      
        Administracion de Seguros de Salud

        April 1, 2019 until May 31, 2020

        PSG (MI Salud} PMPM Premium Rate

        
           

            

          	
                  Rate Cell

                	 	
                  PMPM Premium Rate

                	 
	
                  Law 72, Article VI Public Employees and Pensioners*

                	 	
                  $

                	
                  180.00

                	 


           

            

          
            	II.	
                    RATIFICATION

                  


             

            All other terms and provisions of the original Contract, as amended by Contract Amendments A, B, C, D E and F and of any and all documents
              incorporated by reference therein, not specifically deleted or modified herein shall remain in full force and effect. The Parties hereby affirm their respective undertakings and representations as set forth therein, as of the date thereof.
              Capitalized terms used in this Amendment, if any, shall have the same meaning assigned to such terms in the Contract.

              

            

            	III.	
                    EFFECT; CMS APPROVAL

                  


             

            The Parties agree and acknowledge that this Amendment, including any attachments, is subject to approval by the United States Department of
              Health and Human Services Centers for Medicare and Medicaid Services ("CMS"), and Financial Oversight and Management Board of
              Puerto Rico ("FOMB"); ASES shall submit this Amendment for approval by those regulatory bodies;

            

            

            	IV.	
                    AMENDMENT EFFECTIVE DATE

                  


             

            For purposes of the provisions contained herein, this Amendment shall become effective on April 1, 2020 until May 31, 2020.

            
              

              

              
                	
                        V.

                      	
                        ENTIRE AGREEMENT

                      


              

               

              This Amendment constitutes the entire understanding and agreement of the Parties with regards to the subject matter hereof, and the parties by their execution
                and delivery of this Amendment to the Contract hereby ratify all of the terms and conditions of the Contract, as amended by Contract Number 2019-000052, including amendments A, B, C, D, E, and F as supplemented by this Agreement.

               

              The Parties agree that ASES will be responsible for the submission and registration of this Amendments in the Office of the Comptroller General of the
                Commonwealth, as required under law and applicable regulations.

               

                

              
                
                  	
                          
                            

                          

                        	
                          [Signature Page Follows]

                        	
                          

                        


                   

                    

                

              

              
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              ACKNOWLEDGED BY THE PARTIES by their duly authorized representatives on this 26 day of  february , 2020.

               

                

              
                ADMINISTRACIÓN DE SEGUROS DE SALUD DE PUERTO RICO (ASES)

                
                  

                  

                  	
                          

                        	


                  

                     

                  TRIPLE-S SALUD, INC.

                   

                    

                  	
                          

                        	


                   

                    

                  
                    Account No. 256-5325 to 5330

                    
                      	
                              

                              

                            	
                              
                                
                                  
                                    

                                    

                                    

                                    

                                  

                                  

                              

                            


                    

                    
                      

                      

                      
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                        Exhibit A

                         

                        (Attachment 11)

                        
                           

                            

                          	
                                  
                                    

                                  

                                	
                                  
                                    
                                      
                                        

                                        

                                        

                                        

                                      

                                      
                                      

                                      

                                    

                                  

                                


                           

                            

                          
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                            ATTACHMENT 11