CLIENT SERVICES CONTRACTFor CBO Prevention Services HCA Contract Number: K5263Client Services Contract • July 22nd, 2021 • Washington
Contract Type FiledJuly 22nd, 2021 JurisdictionCONTRACTOR NAME CONTRACTOR DOING BUSINESS AS (DBA) Lewis County Lewis County Public Health and Social Services CONTRACTOR Street City State Zip Code 360 NW NORTH STREET CHEHALIS WA 98532-1925 CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESSdarci.southgate@lewiscountywa.gov Darci Southgage 360-520-0820 Is Contractor a Subrecipient under this Contract? CFDA NUMBER(S): FFATA Form Required YES NO YES NO HCA PROGRAM HCA DIVISION/SECTION CBO Prevention Services Division of Behavioral Health and Recovery/SUDPrevention and MH Promotion Section HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESS Brittany Smith, Contract Manager Health Care Authority626 8th Avenue SE, PO Box 42730 Olympia, WA 98504-2730 HCA CONTACT TELEPHONE HCA CONTACT E-MAIL ADDRESSbrittany.smith@hca.wa.gov 360-819-3570