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CONTRACT HCA Contract No.: K2747 <br />AMENDMENT Amendment No.: 01 <br />For <br />Wa shington State {\(ith --j <br />Healt h Care uth ority ABCD DENTAL SERVICES <br />Kittitas County <br />THIS AMENDMENT TO THE CONTRACT is between the Washington State Health Care Authority <br />and the pa rty whose na me appears below, and is effective as of the date set forth below. <br />CONTRACTOR NAM E CONTRACTOR doing business as (O BA) <br />Kittitas County Public Health Network <br />CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS IDENTIFIER <br />507 North Nanum Street, Suite 201 (UBI) <br />Ellensburg, WA 98926 <br />WHEREAS, HCA and Contractor previously entered into a Contract to provide 'Access to Baby and <br />Child Dentistry' services to detect and prevent early childhood dental decay by engaging dentists in <br />seeing birth to six (6) year old Medicaid eligible children and engaging local public health departments <br />in outreach and case management, and; <br />WHEREAS, HCA and Contractor wish to amend the Contract to provide clarification of 2nd Quarter for <br />Year One 2018-2019 Exhibit A, titled ABCD Quarterly Outreach and Case Management Contract <br />Report, by replacing in its entirety, the Exhibit A for 2nd Quarter contract period; <br />NOW THEREFORE, the parties agree the Contract is amended as follows: <br />1 . Exhibit A. Titled ABCD Quarterly Outreach and Case Management Contract Report. Replace in <br />its entirety, the below revised 2 nd Quarter for Year One 2018-2019 Exhibit A form, for the 10/1/18 <br />through 12/31/18 time period. There are no fiscal allocation changes for this amendment. <br />2. This Amendment will be effective as of the last date of signature shown below ("Effective Date"). <br />3. All capitalized terms not otherwise defined herein have the meaning ascribed to them in the <br />Contract. <br />4. All other terms and conditions of the Contract remain unchanged and in full force and effect. <br />The parties signing below warrant that they have read and understand this Amendment and have <br />authority to execute the Amendment. This Amendment will be binding on HCA only upon signature by <br />HCA. <br />CONTRACTOR SIGNA'TURE <br />HCA Contract No. K27 4 7 <br />Amendment #01 <br />PRINTED NAME AND TITLE <br />·,V"'l ~&Y1 t-a VVl b <br />Administrator <br />PRINTED ~AME A2J;ND TITLE <br />..Ja.;:;es W. Oeylon r-111, ~#l::,. <br />Co~lloels Aeffli111i,,1 o'f '' <br />DATE SIGNED <br />Page 1 of 2