Common Contracts
1 similar null contracts
RFP 2020HCA5, Attachment 2: Draft Sample BH Wraparound ContractDecember 11th, 2019
WASHINGTON BEHAVIORIAL HEALTH SERVICES WRAPAROUND CONTRACT HCA Contract Number: Resulting from Solicitation Number (If applicable): THIS AGREEMENT is 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«Organization_Name» CONTRACTOR ADDRESS«City», «State» «Zip_Code» WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI)«UBI» CONTRACTOR CONTACT«Contact_Fname» «Contact_LName» CONTRACTOR TELEPHONE«PhoneNo» CONTRACTOR E-MAIL ADDRESS«EmailAddress» HCA PROGRAMManaged Care Program HCA DIVISION/SECTIONMedicaid Program Operations and Integrity HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESSPost Office Box 45502 Olympia, WA 98504-5502 HCA CONTACT TELEPHONE HCA CONTACT E-MAIL ADDRESS IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT?YES NO CFDA NUMBER(S) FFATA Form RequiredYES NO CONTRACT START DATEJanuary 1, 2020 CONTRACT END DATEDecember 31, 2020 TO
