SIGNED FINAL 8-18-2023 TB Dispensary2023-2024 Contract DHS - 435100-G24-TBDISPENSE-64 _July 1, 2023 -June 30, 2024

GRANT AGREEMENT
between the
State of Wisconsin Department of Health Services
and
for

DHS Grant Agreement No.:
Tuberculosis (TB) Dispensary Program

Agreement Amount: Sum Sufficient
Agreement Term Period: July 1, 2023, to June 30, 2024 DHS Division: Public Health
DHS Grant Administrator: Patricia Heger DHS Telephone: 608-266-9692
DHS Email: patricia.heger@dhs.wisconsin.gov
Grantee Grant Grantee Teleph

Grantee Email:
Grantee Unique Entity Identifier (UEI) Name: Grantee Unique Entity Identifier (UEI) Number: Grantee 
Supplier ID:

i.gov
ounty of Sauk MBBBU1XPJ4M5
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.
State of Wisconsin
Department of Health Services

Authorized Representative
Name: Title:
Signature:
Date:
Grantee
Entity Name:

Authorized Representative

Name: Title:
Signature:
Date:
DocuSign Envelope ID: E9722D59-99D9-4CF8-82C8-016694BDBEC5

Sauk County Public Health Department
Brent Miller
ty Public Health
Administrator
8/17/2023
Assistant Administrator, Division of Public Health
Anna Benton
8/17/2023