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Department of State Health Services <br />Contractor <br /> <br />Signature of Authorized Official <br />Date: <br />Evelyn Delgado <br />Signature of Authorized Official <br />Date: ____ ?? <br />?_ <br />n <br />t ? <br />Name: ? ? ___.?_?_,__ <br />Assistant Commissioner for Family and Community <br />health Services <br />1.100 WEST 49TH STREET <br />AUSTIN, TEXAS 7$756 <br />(512) 458-7321. <br />Evelyn. De lgado @dsh s. state.tx. us <br />Title: <br />? ?. <br />Address: <br />t- m f, <br />6 ? Y <br />r <br />Phone: <br />?. <br />Email: p _. _ ? ? ? ` -? ?- <br />.Page-2 oft