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Exmm E <br />CONTRACT REPRESENTATIVES AND CONTACT INFORMATION <br />I <br />Kittitas County Sheriff's Office Jail <br />Contact Name <br />Edward Buntin <br />Contact Title <br />Lieutenant <br />Mailing Address 1 <br />205 W 5tt' Ave. Stel <br />Mailing Address 2 <br />City <br />Ellensburg <br />State <br />WA <br />Zip <br />98926 <br />Phone <br />509-962-7527 <br />Fax <br />Email <br />Edward.Buntin@eo.kittitas.wa.us <br />COMMUNITY HEALTH PLAN of WASHINGTON (CHPW) <br />ATTN: Provider Contracting Department <br />Mailing Address <br />I I I I Third Avenue, Suite 400 <br />City <br />Seattle <br />State <br />I WA <br />Zip <br />98101-3292 <br />Email <br />Provider.Contracting0WHPW.org <br />ATTN: Provider Relations Department <br />Mailing Address <br />1111 Third Avenue, Suite 400 <br />City <br />Seattle <br />State <br />WA <br />Zip <br />98101-3292 <br />Phone <br />(206) 521-8833 <br />Fax <br />(206) 613 - 5018 <br />Email <br />Provider.Relations CHPW.or <br />ATTN: Credentialing Department <br />Mailing Address <br />1111 Third Avenue, Suite 400 <br />City <br />Seattle <br />State <br />WA <br />Zip <br />98101-3292 <br />Email <br />Provider. Credentialing ghpw.org <br />2020 Facility Agmt — Template Page 51 of 51 Contract #{Contract #}-{PRC Agreement ID} <br />