ContractWashington Apple Health 2015 Managed Care Contract • January 5th, 2016 • Washington
WASHINGTON APPLE HEALTH 2015 MANAGED CARE CONTRACT HCA Contract Number:«Contract»Contractor Contract Number: Competition Exempt This Contract is between the State of Washington Health Care Authority (HCA) and the Contractor identified below, and is governed by chapter 41.05 RCW, chapter 74.09 RCW and Title 182 WAC. CONTRACTOR NAME «Organization_Name» CONTRACTOR doing business as (DBA) «Mailing_AddressSt_Address»«City», «State» «Zip_Code» WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI)«UBI» HCA INDEX NUMBER CONTRACTOR CONTACT «Contact_Fname»«Contact_LName» CONTRACTOR TELEPHONE «PhoneNo» CONTRACTOR E-MAIL ADDRESS «EmailAddress» HCA CONTACT NAME AND TITLE Alison Robbins Section Manager HCA CONTACT ADDRESS Post Office Box 45502 Olympia, WA 98504-5502 HCA CONTACT TELEPHONE360-725-1634 HCA CONTACT FAXN/A HCA CONTACT E-MAIL ADDRESSalison.robbins@hca.wa.gov IS THE CONTRACTOR A SUB-RECIPIENT FOR PURPOSES OF THIS CONTRACT? No CFDA NUMBER(S) CONTRACT START DATE January 1, 2015 CONTRACT END DATE
