ContractWashington Apple Health Managed Care Contract • May 29th, 2014 • Washington
WASHINGTON APPLE HEALTH MANAGED CARE CONTRACT HCA Contract Number:«Contract»Resulting From Competition 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 70.47; 74.09; and WAC 182. Contractor Contract Number:«Contract» 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 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, 2014 CONTRACT END
