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SHJ25-009 fully executed document
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2025-06-17 10:00 AM - Commissioners' Agenda
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SHJ25-009 fully executed document
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Last modified
9/17/2025 3:19:55 PM
Creation date
9/17/2025 3:19:18 PM
Metadata
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Template:
Meeting
Date
6/17/2025
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
Item
Request to Approve Agreement SHJ25-009 Community Health Plan of Washington - 1115 Medicaid Re-Entry Initiative
Order
16
Placement
Consent Agenda
Row ID
132242
Type
Contract
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Docusign Envelope ID: CEBCGB3C-DFAl -486C-AFE8-6A4A634400B6 <br />The undersigned have executed this Agreement as of the date and year written below <br />Community llealth Plan of Washington Kittitas County Sheriffs Office <br />1111 Third Avenue, Suite 400 <br />Seattle, WA 98101-3292 <br />Phone: (206) 521-8833 <br />by: <br />Sign:U^h, W <br />Name: Erin Hafer <br />Title: Senior Vice President, Delivery & <br />Health System lnnovation <br />Date. 911512025 <br />307 W Umptanum Road <br />Ellensburg, WA 98926 <br />Phone: 509-962-7525 <br />Sign: //*,- M<_ <br />Title: <br />Date: <br />Name: etALl -/uty7-E 5 <br />3t4ER I F l: <br />Contract #5908-662684 <br />2020 Facility Agmt - Template Page 24 of51
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