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Today's Date <br />05/29/2018 <br />Fund/Department <br />116-Public Health <br />Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Agenda Date <br />Contract/Grant Information <br />' <br />(j I I q ( t[)J <br />Contract /Grant Agency: Washington State Immunization Information System Information Sharing <br />Agreement for Exchange of Immunization Data <br />Period Begin Date: June 19, 2018 I I Period End Date: June 19, 2023 <br />Total Grant/Contract Amount: None <br />Grant/Contract Number: <br />Contract/Grant Summary: This agreement is between the Washington State Department of Health <br />Immunization Program and the Kittitas County Public Health Department. The agreement is in place and <br />allows health care providers and health plans to exchange immunization data with other health care <br />providers and health plans. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: ~ 1 Administrator Date:~{ll <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />/4 / . 1. {:;-!//J <br />Date <br />Date <br />Signature of Board of Health member Date <br />Financial Information <br />Total Amount$ State Funds$ Federal Funds$ <br />Percentage County Funds Matching Funds$ CFDA# <br />In -Kind$ <br />Explain <br />Grant/Contract Review Page 1