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Health Care Authority
6218th Avenue SE
Olympia, WA 98504
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Grant County
840 E Plum St
Moses Lake, WA 98837
Ape My No. AgryamalMmwCantnct Numbr
1070 K3919
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TAX IDENTIFICATION NUMBER MONTHIYEAR
91-6001319
OF SERVICE
Jun-za
RECEIVED BY
DATE RECEIVED
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MHPP Tool
11.1 Admin
Ml 62 61449
1,226.11
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0.00
22.5 Community Coal—Cawdlnator Community -Based Process
Universal -Direct
o.00
22.5 Community Coaly- Canmumy-Based Process
Universal -Direst
0.00
000
22.5.1 Cnnmuniy Coalition Cowdinatar ML C munit,,Basal Process
Universal -Direct
5813.59
5,813.59
2251 CommunityCdition Coalition- Community-Basod Pass
Universal-Dilml
0 M
0.00
222.1 FAX -GBG- SuPPlles-ML Education
Universal-Oirwt
1814.18
1,614.18
22 51 General Coale- Youth Program SuIIML CanmunityBased Process
UnEw-kDvwt
823.84
823 84
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0,00
22,51 Community Coalition Coordinator -Quincy CommunityBmed Process
Universal -Direct
7.738.46
7,738.48
225.1 CwnmuMty Do— Coelidon- Supplies-O-cy CommunityBasad Process
Universal-D—t
142.67
142.67
0.00
2211 Media Awwe— Campang- Quincy In(ormatim Disacnination
Unnersal-Direct
17500
1 150
0.00
0.00
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0.00
900
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2.02
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8,251.61
SB182 0.00 0.00 BOB 1 000 1 owl
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0.00 0.00 17,533.85
PREPARED BYI DATE TELEPHONE
Rayne Gonzales 081101202050e
1642660
A19 Effective 7/1119 through 6/30121 REVISED 1/21/2020
DDATE
L:OC
VENDOR NO. AGENCY APPROVASWV0002426.00 Sarah Mariani, 360-725-9401, Sarah.Mariani@hca.wa.gov
UNTING APPROVAL FOR PAYMENTI DATE
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