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Washington State <br />Health Care Authority Page 1 of 53 Contract # 2747 <br /> <br /> <br />PROFESSIONAL SERVICES <br />CONTRACT <br /> for <br />ABCD DENTAL SERVICES <br />Kittitas County <br />HCA Contract Number: K2747 <br /> <br />Contractor/Vendor Contract Number: <br />THIS CONTRACT is made by and between Washington State Health Care Authority, (HCA) and the <br />(Contractor). <br />CONTRACTOR NAME CONTRACTOR DOING BUSINESS AS (DBA) <br />Kittitas County Public Health Network <br />CONTRACTOR ADDRESS Street City State Zip Code <br />507 NORTH NANUM STREET, SUITE 201, ELLENSBURG, WA <br />98926 <br />CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESS <br />Kasey Knutson 509-962-7029 kasey.knutson@co.kittitas.wa.us <br />Is Contractor a Subrecipient under this Contract? CFDA NUMBER(S): FFATA Form Required <br /> YES NO 93.778 YES NO <br /> <br /> <br /> <br /> <br /> <br />HCA PROGRAM HCA DIVISION/SECTION <br />ABCD Dental Program Clinical Quality and Care Transformation (CQCT) <br />HCA CONTACT NAME AND TITLE <br /> <br /> <br />HCA CONTACT ADDRESS <br /> <br />Janice Tadeo, Dental Program Manager <br />Health Services and Management <br />Clinical Quality and Care Transformation (CQCT) <br />Health Care Services <br />Health Care Authority <br />626 8th Avenue SE <br />PO Box 42702 <br />Olympia, WA 98504 <br />HCA CONTACT TELEPHONE HCA CONTACT E-MAIL ADDRESS <br />(360) 725-1583 Janice.Tadeo@hca.wa.gov <br /> <br />CONTRACT START DATE CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT <br />July 1, 2018 June 30, 2020 $19,000.00 <br />PURPOSE OF CONTRACT: <br /> <br /> <br />Provide ‘Access to Baby and Child Dentistry’ (ABCD) services to detect and prevent early childhood dental decay by <br />engaging dentists in seeing birth to six (6) year old Medicaid eligible children and engaging local public health <br />departments in outreach and case management. <br /> The parties signing below warrant that they have read and understand this Contract, and have authority to <br />execute this Contract. This Contract will be binding on HCA only upon signature by HCA. <br />CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED <br /> Robin Read <br />Administrator <br />HCA SIGNATURE PRINTED NAME AND TITLE DATE SIGNED <br /> James W. Gayton <br />Contracts Administrator