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Washington StatePROFESSIONAL <br />SERVICES <br />HCA Contract Number: K5885 <br />Health Care kuf'hoority <br />CONTRACT for <br />MOUD in Jails <br />Resulting from Solicitation Number (If <br />applicable: 2021HCA42 <br />205 W 5ih Ave, Ste 11Jail <br />Ellensburg WA 98926 <br />Contractor/Vendor Contract Number: <br />THIS CONTRACT is made by and between Washington State Health Care Authority, (HCA) and Kittitas <br />County Sheriff, (Contractor), <br />CONTRACTOR NAME <br />CONTRACTOR DOING BUSINESS AS (DBA) <br />Kittitas County <br />Kittitas County Sheriff - Jail <br />CONTRACTOR ADDRESS I Street <br />City I State I Zip Code <br />205 W 5ih Ave, Ste 11Jail <br />Ellensburg WA 98926 <br />CONTRACTOR CONTACT CONTRACTOR TELEPHONE <br />CONTRACTOR E-MAIL ADDRESS <br />Edward L. Buntin 509-962-7527 <br />edward.buntingco.kittitas.wa.us <br />Is Contractor a Subrecipient under this Contract? <br />CFDA NUMBER(S): <br />FFATA Form Required <br />❑YES ®NO <br />NIA <br />❑YES ®NO <br />HCA PROGRAM <br />MOUD in Jails Program <br />HCA DIVISION/SECTION <br />DBHR <br />HCA CONTACT NAME AND TITLE <br />HCA CONTACT ADDRESS <br />June 30, 2022 <br />Health Care Authority <br />Rachel Meade, MOUD in ,fails Program Administrator <br />626 8th Avenue SE <br />PO Box 45330 <br />Olympia, WA 98504-5330 <br />HCA CONTACT TELEPHONE <br />HCA CONTACT E-MAIL ADDRESS <br />(360) 725-2009 <br />rachel.meadeCd�hca.wa.gov <br />CONTRACT START DATE <br />CONTRACT END DATE <br />TOTAL MAXIMUM CONTRACT AMOUNT <br />March 1, 2022 <br />June 30, 2022 <br />$271,035.00 <br />PURPOSE OF CONTRACT: <br />To develop and implement or continue to expand MOUD in jails program. <br />The parties signing below warrant that they have read and understand this Contract and have authority to <br />execute this Contract. This Contract will be binding on HCA only upon signature by both parties. <br />CONTRACTOR SIGNATURE <br />Q <br />PRINTED NAME AND TITLE <br />e" i ,'-? Si -(e IFS <br />DATE SIGNED <br />HCA SIGNATURE <br />PRINTED NAME AND TITLE <br />DATE SIGNED <br />OMMY1.91 1k] <br />