ContractInterlocal Agreement • July 6th, 2018 • Washington
Contract Type FiledJuly 6th, 2018 JurisdictionPEBB EMPLOYER GROUP INTERLOCAL AGREEMENT HCA Contract Number: K2824 Employer Group Agency Number: 900 D39 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 #2, hereinafter referred to as the "Contractor." EMPLOYER NAMESan Juan County Public Hospital District #2 EMPLOYER doing business as (DBA) EMPLOYER GROUP ADDRESS262 Weeks Road, PO Box 976 Lopez Island, WA 98261 FEDERAL TAX ID #:82-1576048 WA STATE UBI #: EMPLOYER BARGAINING GROUP:All employees EMPLOYER CONTACTAnne Presson EMPLOYER TELEPHONE(360) 622-2729 EMPLOYER E-MAIL ADDRESSapresson@lopezislandhd.org HCA PROGRAMPEB Outreach and Training HCA DIVISION/SECTIONEmployee