Program 1 Other markets/details for Row Program 1 Number Name of Payment Reform 65 words. N/A 1 Program and Name and contact details (email and phone) of contact person who can answer questions about program being described Contact Name for Payment 5 words. N/A 2 Reform Program (person who can answer questions about the program being described) Contact Person's Title 5 words. N/A 3 Contact Person's Email 5 words. N/A 4 Contact Person's Phone 5 words. N/A 5 Contact Name for person who is 5 words. N/A 6 authorized to update this program entry in ProposalTech after Contractor has submitted response (if same as contact name for the payment reform program, please reenter his/her name) Email for person authorized to 5 words. N/A 7 update this program entry in ProposalTech after Contractor has submitted response (if same as contact email for the payment reform program, please reenter his/her email) Geographic Covered California Single, Radio group. Multi, List box. 8 region of named payment reform 1: Not in this market (Identify market 1: Alpine, Del Norte, Siskiyou, in column to the right), Modoc, Lassen, Shasta, Trinity, program 2: In this market and other markets Humboldt, Tehama, Plumas, (Ctrl-Click for multiple states) (Identify market(s) in column to the Nevada, Sierra, Mendocino, Lake, right), Butte, Glenn, Sutter, Yuba, 3: Only in this market Colusa, Amador, Calaveras, and Tuolumne, 2: Napa, Sonoma, Solano, and Marin, 3: Sacramento, Placer, El Dorado, and Yolo, 4: San Francisco, 5: Contra Costa, 6: Alameda,
Program 1 Other markets/details for Program 1 Row Number Name of Payment Reform Program and Name and contact details (email and phone) of contact person who can answer questions about program being described 65 words. N/A 1 Contact Name for Payment Reform Program (person who can answer questions about the program being described) 5 words. N/A 2 Contact Person's Title 5 words. N/A 3 Contact Person's Email 5 words. N/A 4 Contact Person's Phone 5 words. N/A 5 Contact Name for person who is authorized to update this program entry in ProposalTech after Contractor has submitted response (if same as contact name for the payment reform program, please reenter his/her name) 5 words. N/A 6 Email for person authorized to update this program entry in ProposalTech after Contractor has submitted response (if same as contact email for the payment reform program, please reenter his/her email) 5 words. N/A 7 Geographic Covered California region of named payment reform program (Ctrl-Click for multiple states) Single, Radio group. 1: Not in this market (Identify market in column to the right), 2: In this market and other markets (Identify market(s) in column to the right), 3: Only in this market Multi, List box. 1: Alpine, Del Norte, Siskiyou, Modoc, Lassen, Shasta, Trinity, Humboldt, Tehama, Plumas, Nevada, Sierra, Mendocino, Lake, Butte, Glenn, Sutter, Yuba, Colusa, Amador, Calaveras, and Tuolumne, 2: Napa, Sonoma, Solano, and Marin, 3: Sacramento, Placer, El Dorado, and Yolo, 4: San Francisco, 5: Contra Costa, 6: Alameda, 8
Qualified%20Health%20Plan%20Certification%20Application%20Fourth%20Quarter%202017%20Smal....docx