HCA Amendment for Prevention Services

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This Contract between the State of Washington Health Care Authority (HCA) and the Contractor is hereby amended as follows: 1. Amend the following by deleting and replacing: Federal Award Identification for Subrecipients (reference 2 CFR 200.331) - Substance Abuse Block Grant (i) Subrecipient name (which must match the name associated with its unique entity identifier); (ii) Subrecipient's unique entity identifier; (DUNS) (iii) Federal Award Identification Number (FAIN); (iv) Federal Award Date (see §200.39 Federal award date); (v) Subaward Period of Performance Start and End Date; (vi) Amount of Federal Funds Obligated by this action; (vii) Total Amount of Federal Funds Obligated to the subrecipient; (xiii) Total Amount of the Federal Award; (ix) Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA); (x) Name of Federal awarding agency, pass- through entity, and contact information for awarding official, (xi) CFDA Number and Name; the pass-through entity must identify the dollar amount made available under each Federal award and the CFDA number at time of disbursement; Kittitas County 010202547 S M010056 04/17/2015 4/1/18 to 6/30/19 -$2,956 $86,145 FY14 $37,271,989 FY15 $37,296,186 FY16 $38,042,110 Substance Abuse Prevention and Treatment Block Grant SAMHSA, Washington State DSHS, Chris Imhoff, Director PO Box 45330 Olympia, WA 98504-5330 ImhofcC�dshs.wa.aov 93.959 (xii) Identification of whether the award is R&D; and ® Yes ❑ No (xiii) Indirect cost rate for the Federal award 5% (including if the de minimis rate is charged per §200.414 Indirect (F&A) costs). HCA Contract Services Page 2 7024PF HCA Custom Contract Amendment (5-2-2018)