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42 <br /> ORANGE COUNTY ORANGE COUNTY <br /> NORTH CAROLINA HIGH IMPACT OPIOID ABATEMENT <br /> STRATEGIES <br /> Funding Proposal Application Form <br /> Application Due Date: February 21, 2025 <br /> Applicant Agency: General Information <br /> Legal Name Piedmont Health Services, Inc. <br /> Address 88 Vilcom Center Dr. Ste 110 Chapel Hill NC 27514 <br /> Type of Agency ❑ Government/ <br /> (check one) Public Authority ❑X Non-Profit ❑ For-Profit Business <br /> Telephone 919-933-8494 <br /> Website www.pied monthealth.org <br /> Primary Contact Full Name Jasmine Fouts <br /> Title Grants Manager <br /> Email foutsi@piedmonthealth.org <br /> Telephone 919-933-8494 <br /> Name of Project I Community MOUD for Orange County <br /> Total Application Funding Requested IT 50,400 <br /> Funding Period Requested Start FDateTJune <br /> (MM/DD/YYYY) Date July 12025 30 2026 <br /> Selected NC MOA Option A Strategy(Number <br /> and Name) 2. Evidence-based addiction treatment <br /> Agency Mission and Vision Statements Our Mission:To improve the health and well- <br /> being of the community by providing high- <br /> quality, affordable, and comprehensive primary <br /> health care. <br /> Our Vision: Our vision is a healthy community <br /> in which all people have timely access to quality <br /> health care. <br /> i <br />