SIGNED FINAL 6-21-23_SAUK CO PHD - DHS_ForwardHealth Program Services - 435400-G24-56-430

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Template Revision: 2/1/2023 (previous templates no longer usable)
GRANT AGREEMENT
between the
State of Wisconsin Department of Health Services
and
SAUK CO PHD
for
Public Health Outreach Services for ForwardHealth Program Services
DHS Grant Agreement No.: 435400-G24-56-430 Agreement Amount: $28,670
Agreement Term Period: 7/1/2023 to 6/30/2024 CARS Pre-Packet No: 23706
DHS Division: Division of Medicaid Services DHS Grant Administrator: Myesha Thompson DHS Telephone: 
608-772-4813
DHS Email: myesha.thompson1@dhs.wisconsin.gov
Grantee Grant Administrator: Andrew Ringquist Grantee Telephone: 608-355-4342
Grantee Email: andrew.ringquist@saukcountywi.gov Grantee Unique Entity Identifier (UEI) Name: Sauk 
County
Grantee Unique Entity Identifier (UEI) Number: MBBBU1XPJ4M5 Grantee FEIN: 39-6005740
DHS and the Grantee acknowledge that they have read the Agreement and the attached documents, 
understand them and agree to be bound by their terms and conditions. Further, DHS and the Grantee 
agree that the Agreement and the exhibits and documents incorporated herein by reference are the 
complete and exclusive statement of agreement between the parties relating to the subject matter of 
the Agreement and supersede all proposals, letters of intent or prior agreements, oral or written 
and all other communications and representations between the parties relating to the subject matter 
of the Agreement. DHS reserves the rights to reject or cancel Agreements based on documents that 
have been altered. This Agreement becomes null and void if the time between the earlier dated 
signature and the later dated signature exceeds
sixty (60) days, unless waived by DHS.