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Washington State <br />Health Care . <br />PROFESSIONAL SERVICES <br />CONTRACT <br />for <br />ABCD DENTAL SERVICES <br />Kittitas County <br />HCA Contract Number: K2747 <br />Contractor/Vendor Contract Number: <br />THIS CONTRACT is made by and between Washington State Health Care Authority, (HCA) and the <br />(Contractor). <br />CONTRACTOR NAME CONTRACTOR DOING BUSINESS AS (DBAl <br />Kittitas County Public Health Network <br />CONTRACTOR ADDRESS [ Street City State Zip Code <br />507 NORTH NANUM STREET, SUITE 201, ELLENSBURG, WA <br />98926 <br />CONTRACTOR CONTACT I CONTRACTOR TELEPHONE I CONTRACTOR E-MAIL ADDRESS <br />Kasey Knutson 509-962-7029 kasey.knutson@co.kittitas.wa.us <br />Is Contractor a Subrecioient under this Contract? I CFDA NUMBER(S): I FFATA Form Required •YES ~NO 93.778 ~YES •NO <br />HCA PROGRAM HCA DIVISION/SECTION <br />ABCD Dental Program Clinical Quality and Care Transformation (CQCT) <br />HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESS <br />Janice Tadeo, Dental Program Manager <br />Health Care Authority <br />626 8th Avenue SE <br />Health Services and Management PO Box 42702 <br />Clinical Quality and Care Transformation (CQCT) <br />Olympia, WA 98504 <br />Health Care Services <br />HCA CONTACT TELEPHONE HCA CONTACT E-MAIL ADDRESS <br />(360) 725-1583 Janice. Tadeot@hca .wa .gov <br />CONTRACT START DATE CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT <br />July 1, 2018 June 30, 2020 $19,000.00 <br />PURPOSE OF CONTRACT: <br />Provide 'Access to Baby and Child Dentistry' (ABCD) services to detect and prevent early childhood dental decay by <br />engaging dentists in seeing birth to six (6) year old Medicaid eligible children and engaging local public health <br />departments in outreach and case management. <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 HCA. <br />Washington State <br />Health Care Authority <br />PRINTED NAME AND TITLE <br />Robin Read <br />Administrator <br />PRINTED NAME AND TITLE <br />James W. Gayton <br />Contracts Administrator <br />Page 1 of 53 <br />DATE SIGNED <br />{e(:?7{ <br />OA,TE Sl f NED <br />, 2~\1.t,> <br />Contract# 2747