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HCA Amendment Signed
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2022
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07. July
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2022-07-19 10:00 AM - Commissioners' Agenda
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HCA Amendment Signed
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Last modified
7/25/2022 8:11:19 AM
Creation date
7/25/2022 8:10:52 AM
Metadata
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Template:
Meeting
Date
7/19/2022
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Fully Executed Version
Supplemental fields
Alpha Order
d
Item
Request to Approve an Amendment to the Health Care Authority Access to Baby Dentistry
Order
4
Placement
Consent Agenda
Row ID
91496
Type
Agreement
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DocuSign Envelope lD: FF 1 48287 -E90C-4289-840F-A1 4FA00E82AFExhibit A-3Please complete and submit report electronically to:Janice Tadeo, ABCD Program Manager at ianice.tadeo@hca.wa.qovCc: Pixie Needham, Dental Program Administrator at pixie.needham@hca.wa.gov andHeath er Gallagher, ABCD State Managi n g Director, hqallaq her@arcorafoundation. orgABCD Quarterly Community and Provider Outreach and Case Management ReportYear Two July 1, 2023 - June 30,2024.4th Ouarter ReportBrief description (for events, provide date held/attended/ forstaff assignments, provide name and title) - no more than100 words (complete Exhibit A-3 and attach supportingdocument if providing additional detail)Colete Exhibit B-3Complete Exhibit B-3Complete Exhibit B-3Maximum$$ availablefor thisdeliverable$1.000.00$100.00$1,298.00$324.004th Quarter4t1t2024 -6t30t2024Yes/NoOrqanizationABCD Contact Person:Phone and Email:Report Due:.0710912024 (report due on thisdate to allow HCA to close out fiscal vear)Performance CateqorVAttend and participate in ABCDCoord inator/Program MeetingUpdate ABCD orovider roster to DentistlinkCommunity and Provider OutreachCoordinate CareHCA Contract No.: K2747-04Page 15 of 20
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