State of Mississippi, Department of VENDOR NAME Information Technology Services, on behalf of Mississippi Division of Medicaid By:_______________________________ By:_______________________________ Authorized Signature Authorized Signature Printed Printed Name: Craig P. Orgeron, Ph.D. Name:____________________________ Executive Director Title:_____________________________ Date: ______________________________ Date:_____________________________ EXHIBIT A Schedule of Payment Deliverables Deliverable Deliverable Cost Less 15% Amount Paid Retainage
State of Mississippi, Department of Information Technology Services, on behalf of Mississippi Division of Medicaid VENDOR NAME By:_______________________________ By:_______________________________ Authorized Signature Authorized Signature Printed Name: Craig P. Orgeron, Ph.D. Printed Name:____________________________ Executive Director Title:_____________________________ Date: ______________________________ Date:_____________________________ EXHIBIT A Schedule of Payment Deliverables Deliverable Deliverable Cost Less 15% Retainage Amount Paid
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