ContractBho Program Agreement Path Hca Agreement • October 19th, 2018
BHO PROGRAM AGREEMENT PATH HCA Agreement Number: K3143 This BHO Program Agreement is by and between the State of Washington Health Care Authority (HCA) and the Contractor identified below, and is issued in conjunction with the HCA and BHO Agreement on General Terms and Conditions (GT&C), which is incorporated by reference. BHO GT&C Contract Number: Contractor Contract Number: CONTRACTOR NAMEGreat Rivers Behavioral Health Organization CONTRACTOR doing business as (DBA)North Sound BHO (Compass) CONTRACTOR ADDRESSPO Box 217Cathlamet, WA. 98612-0217 WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI)603-564-565 HCA INDEX NUMBER CONTRACTOR CONTACTMarc Bollinger CONTRACTOR TELEPHONE(360)795-5959 CONTRACTOR E-MAIL ADDRESSmbollinger@greatriversbho.org HCA DIVISION Division of Behavioral Health and Recovery HCA CONTRACT CODE HCA CONTACT NAME AND TITLE Teesha Kirschbaum Program Administrator HCA CONTACT ADDRESS 4500 10th Avenue SE Lacey, WA. 98503 HCA CONTACT TELEPHONE(360)725-3772 HCA CONTACT FAX H
