Common Contracts
1 similar Data Share Agreement contracts
ContractData Share Agreement • September 10th, 2015
Data Share Agreement [Name of System] HCA Contract Number: KXXX Receiving Party Contract Number: This Data Share Agreement (“Agreement” or “DSA”) is made by and between the state of Washington Health Care Authority (“HCA”) and the party whose name appears below, (“Receiving Party”) Receiving Party Name Receiving Party doing business as (DBA) Receiving Party Address Receiving Party Contact Name, Title Receiving Party Contact Telephone Receiving Party Contact Email Address HCA Program HCA Division/Section HCA Contact Name, Title HCA Contact Address 626 8th Avenue SE, PO Box 4xxxx Olympia, WA 98504-xxxx HCA Contact Telephone HCA Contact Email Address The parties signing below warrant that they have read and understand this Agreement, and have authority to execute this Agreement. This Agreement shall be binding on HCA only upon signature by HCA. Receiving Party Signature Printed Name and Title Date Signed HCA Signature Printed Name and Title Date Signed Me
