moamendment9.htm


    Back to Form
8-K

    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

            


    

    
      


       

    

    
      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

       

       

      STATE OP
MISSOURI

    

    
      OFFICE OF
ADMINISTRATION

    

    
      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

    

    
       

    

    
       

      RETURN
AMENDMENT TO:

    

    
      	
               

              (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

    

    
      Post
Office Box 6500

    

    
      Jefferson
City MO 05102-6500

       

    

    
      SIGNATURE
REQUIRED

       

      


    

    
      	
               

              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

            


    

    
      

        
          
             


          

          
             


            
              

            

          

          
             


          

        

Contract
C306118005

    

    


    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.