SIGNED FINAL Sauk Co PH - PH Outreach Services for FORWARDHEALTH Program Services - 435400-G26-56-30 6-14-2025

DHS Grant Agreement Non . 435400-G26 -56-30
Agreement Amount. $ 28 P 670
Agreement Term Period. July 1 P 2025 to June 30P 2026 GEARS Pre-Packet No. 29942
DHS Division. Division of Medicaid Services DHS Grant Administrator. Sabrina Zahn DHS Telephone. 
NIA
DHS Email. sabrinan zahn@dhsn wisconsinn gov

Grantee Grant Administrator. Jody Bruni Grantee Telephone. NIA
Grantee Email. Jodyn Bruni@saukcountywin gov Grantee Unique Entity Identifier (UEI) Name.

County of Sauk

Grantee Unique Entity Identifier (UEI) Number. MBBBU XPJ4M5

DHS and the Grantee acknowledge that they have read the Agreement and the attached documentsP 
understand them and agree to be bound by their terms and conditionsn FurtherP 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 proposalsP letters of intent or prior agreementsP oral or written 
and all other communications and representations between the parties relating to the subject matter 
of the Agreementn DHS reserves the rights to reject or cancel Agreements based on documents that 
have been alteredn This Agreement becomes null and void if the time between the earlier dated 
signature and the later dated signature exceeds sixty (60) daysP unless waived by DHSn