Common Contracts
1 similar Business Associate Agreement contracts
EXHIBIT E – HCA DRAFT SAMPLE CONTRACT & BUSINESS ASSOCIATE AGREEMENT (BAA)Business Associate Agreement • August 25th, 2014 • Washington
CONTRACT HCA Contract Number: Resulting from Solicitation Number (If applicable): 14-002 EQRO THIS AGREEMENT made by and between Washington State Health Care Authority, hereinafter referred toas "HCA," and the party whose name appears below, hereinafter referred to as the "Contractor." CONTRACTOR NAME CONTRACTOR doing business as (DBA) CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI) CONTRACTOR CONTACT CONTRACTOR TELEPHONE( ) CONTRACTOR E-MAIL ADDRESS HCA PROGRAMManaged Care HCA DIVISION/SECTIONHCS/QCM HCA CONTACT NAME AND TITLEBarbara Lantz, MN, RN Manager, QCM HCA CONTACT ADDRESSPO Box 45530Olympia, WA 98504-0553 HCA CONTACT TELEPHONE(360) 725-1640 HCA CONTACT E-MAIL ADDRESSBarbara.lantz@hca.wa.gov IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT?YES NO CFDA NUMBER(S)93.778 FFATA Form RequiredYES NO CONTRACT START DATE January 1, 2015 CONTRACT END DATE December 31, 2017 TOTAL MAXIMUM CONTRACT AMOUNT PURPOSE OF CONTRACT:To conduct External Quality Rev
