Request for Bids for Implementation of Evidence-Based Interventions to Improve Cervical Cancer Screening among New York State (NYS) Primary Care Clinics

Section 1: Health System / Clinic Location and Contact Information

Question Title

* 1. Parent Health System Name

Question Title

* 2. Parent Health System Address (main location or administrative offices)

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Question Title

* 3. Parent Health System Tax ID Number (TIN)

Question Title

* 4. Sam.gov Unique Entity Identification Number

Question Title

* 5. Clinic Name

Question Title

* 6. Clinic Address

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Question Title

* 7. Primary Contact Person for the Bid

Name

Organizational Title

Email Address

Phone Number

Question Title

* 8. Organization Contract Signatory
The individual who has the appropriate and official authority to receive and agree to the terms and conditions set forth in the contract

Name

Organizational Title

Email Address

Phone Number

Question Title

* 9. Total number of clinic sites in the practice or health system that provide primary care services
Do not include school-based health clinics

Question Title

* 10. What New York State Department of Health (NYSDOH) Cancer Services Program (CSP) does this clinic participate in?

CSP of the Bronx - Lincoln Medical and Mental Health Center

CSP of Brooklyn - The Brooklyn Hospital Center

CSP of Cayuga, Cortland, and Tompkins - Cortland County

CSP of the Central Region - Mary Imogene Bassett Hospital

CSP of Erie County - Erie County

CSP of the Finger Lakes - University of Rochester Medical Center

CSP of Fulton, Montgomery, and Schenectady - St. Mary's Healthcare

CSP of Genesee, Orleans, Wyoming, and Niagara - United Memorial Medical Center

CSP of the Greater Capital Region - St. Peter's Healthcare

CSP of the Hudson Valley - Open Door Family Medical Center, Inc.

CSP of Manhattan - The New York Presbyterian Hospital

CSP of Nassau County - Long Island Jewish Medical Center

CSP of the North Country - Oswego County Opportunities, Inc.

CSP of Northeastern New York - Champlain Valley Physicians Hospital Medical Center

CSP of Onondaga County - Onondaga County

CSP of Queens - New York Presbyterian / Queens Hospital

CSP of the Southern Tier - Broome County

CSP of Staten Island (Richmond) - Staten Island University Hospital

CSP of Steuben, Allegany, Cattaraugus, and Chatauqua - St. James Mercy Hospital

CSP of Suffolk County - Central Suffolk Hospital

CSP of Warren, Washington, and Hamilton - Glens Falls Hospital

None of the above

12% of survey complete.

Request for Bids for Implementation of Evidence-Based Interventions to Improve Cervical Cancer Screening among New York State (NYS) Primary Care Clinics

Section 1: Health System / Clinic Location and Contact Information

Question Title

* 1. Parent Health System Name

Question Title

* 2. Parent Health System Address (main location or administrative offices)

Question Title

* 3. Parent Health System Tax ID Number (TIN)

Question Title

* 4. Sam.gov Unique Entity Identification Number

Question Title

* 5. Clinic Name

Question Title

* 6. Clinic Address

Question Title

* 7. Primary Contact Person for the Bid

Question Title

* 8. Organization Contract SignatoryThe individual who has the appropriate and official authority to receive and agree to the terms and conditions set forth in the contract

Question Title

* 9. Total number of clinic sites in the practice or health system that provide primary care servicesDo not include school-based health clinics

Question Title

* 10. What New York State Department of Health (NYSDOH) Cancer Services Program (CSP) does this clinic participate in?

* 8. Organization Contract Signatory
The individual who has the appropriate and official authority to receive and agree to the terms and conditions set forth in the contract

* 9. Total number of clinic sites in the practice or health system that provide primary care services
Do not include school-based health clinics