ContractWashington • May 5th, 2020
Jurisdiction FiledMay 5th, 2020INTERAGENCYAGREEMENT School District Reimbursement HCA Contract Number: 1234-56789 Amendment Number: 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 PROGRAM School-Based Health Care Services HCA DIVISION/SECTION MPOI/Community Services HCA CONTACT NAME AND TITLEShanna MuirheadSBHS Program Specialist HCA CONTACT ADDRESSPO Box 45530Olympia, WA 98504-5530 HCA CONTACT TELEPHONE(360) 725-1153 HCA CONTACT E-MAIL ADDRESSshanna.muirhead@hca.wa.gov IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT?YES NO CFDA NUMBER(S) FFATA Form RequiredYES NO CONTRACT START DATEDate of Execution CONTRACT END DATE6/30/2019 TOTAL MAXIMUM CONTRACT AMOUNT: No Max PURPOSE O
ContractWashington • May 19th, 2016
Jurisdiction FiledMay 19th, 2016INTERAGENCYAGREEMENT School District Reimbursement HCA Contract Number: K1754 Amendment Number: 1 THIS AGREEMENT made by and between Washington State Health Care Authority, hereinafter referred to as "HCA," and the party whose name appears below, hereinafter referred to as the "Contractor." CONTRACTOR NAME Oak Harbor School District No. 201 CONTRACTOR doing business as (DBA) CONTRACTOR ADDRESS350 S Oak Harbor Street Oak Harbor, WA 98277 WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI)153-000-057 CONTRACTOR CONTACT Vicki Williams CONTRACTOR TELEPHONE (360) 279-5009 CONTRACTOR E-MAIL ADDRESS vwilliams@ohsd.net HCA PROGRAM School-Based Health Care Services HCA DIVISION/SECTION MPOI/Community Services HCA CONTACT NAME AND TITLEShanna MuirheadSBHS Program Specialist HCA CONTACT ADDRESSPO Box 45530Olympia, WA 98504-5530 HCA CONTACT TELEPHONE(360) 725-1153 HCA CONTACT E-MAIL ADDRESSshanna.muirhead@hca.wa.gov IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT?YES NO CFDA NUMBER(S)
ContractWashington • October 2nd, 2015
Jurisdiction FiledOctober 2nd, 2015INTERAGENCYAGREEMENT School District Reimbursement HCA Contract Number: THIS AGREEMENT made by and between Washington State Health Care Authority, hereinafter referred to as "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 PROGRAM School-Based Health Care Services HCA DIVISION/SECTION HCS/Community Services HCA CONTRACT CODE N/A HCA CONTACT NAME AND TITLEShanna MuirheadSBHS Program Specialist HCA CONTACT ADDRESSPO Box 45505Olympia, WA 98504-5505 HCA CONTACT TELEPHONE(360) 725-1153 HCA CONTACT E-MAIL ADDRESSharvej@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 CONTRACT END DATEJune 30, 2019 TOTAL MAXIMUM CONTRACT AMOUNT: No Max PURPOSE OF CONTRACT:To establish