ContractEmployer Group Interlocal Agreement • May 31st, 2022 • Washington
PEBB EMPLOYER GROUP INTERLOCAL AGREEMENT HCA Contract Number: K6028 Employer Group Agency Number: 900 D71 Washington State Health Care Authority is the single state agency that administers the medical, dental, life, and disability insurance coverage for the Employees of the State of Washington and for contracted employer groups, as set forth in Title 41 RCW. THIS Interlocal Agreement made by and between Washington State Health Care Authority, hereinafter referred to as "HCA," and San Juan County Public Hospital District #3, hereinafter referred to as the "Contractor." EMPLOYER NAMESan Juan County Public Hospital District #3 EMPLOYER doing business as (DBA) EMPLOYER GROUP ADDRESSPO Box 226Eastsound, WA 98245 FEDERAL TAX ID #:83-0531685 WA STATE UBI #: EMPLOYER BARGAINING GROUP:All Employees EMPLOYER CONTACTTom Eversole EMPLOYER TELEPHONE(360) 317-3545 EMPLOYER E-MAIL ADDRESStome@orcashealth.org HCA PROGRAMPEB Outreach and Training HCA DIVISION/SECTIONEmployees and Retirees Benefits (E
