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HomeMy WebLinkAboutReimbursable Work Request - GRISForm O S.le of Wasdinglon ' A191A Inwlce Voucher At�'CY NAS Heahh Care Authority 6218th Avenue SE Olympia, WA 98504 VtlDgl Ca LLLMA\T Grant County 840EPIumSt Moses Lake, WA98837 e Apney No. Agreement ID or Contract Numtar 1070 K3919 vends IA-are Inerebyfet°y Ones. penemfdPe-iv.r mal me aemsane reals 1- beamare F.ope cnarges ror male-ials.me-unaneisaosa srergga viiasningrm. ane martil goods ru nisneabnac. se.Nces endo-ee Here bean pa ned-0.1 d1--bar<use doge. sa:, naegr uipm. handicap rengie,. a vlemam ea, bled referane L I9s iiiP 9941 r i [� ((��((''�� (signinink) Cindy Cale h BOCC Chair loos) (data) qua:m msnae ro rna mariral sranss, race. Daae caa. TAX IDENTIFICATION NUMBER MONTH/E AR OF SERVICE 91-6001319 May'20 Supplenentai RECE111D BV DATERECEIVED aAR9 P11oGRAY ACDNLY YAYE CHP aiMTEGY pY SASG GFS PFS MIB PFS DMA ITR NGE SOR SORIupp c.,-, E9P PP Genets -­.-YHPP TOMI 11.1 Admin 0 0.00 21 Canmunity-Based Coordination-Pa canmunity-Based Process Unrvwr -Indirect 0.00 22.5 Community Coalition Cmd'mator Community-Based P-eas U,-r -Direct 0.00 22 5 Community Coalition Community-Based Process Unive Direct 0.00 000 22.5.1 Community Coalition Coordinator-ML Community-Based Prxess Universal-Direct 0.00 2251 Coavnunity CI,bm Coalition-Supplies-ML Community-Based Prxess Universal-Direct 0.00 0.00 2221 PAX-GBG-Supplles-ML Education Univesal-Direct 1.146.29 4.29 0.00 0 DO 000 2251 Community Ccalllion Coordinator-Ouincy Community-Based Prxess UPlversa1-0.1ect 0.00 2251 Cmmunty Cdiuon Coalition-SupPI-Quincy C-nily-Basad Prxess UNvesel-Dart 0.00 0.00 22.1.1 Med. Awar- Campaing-0uincy Information Dissemination Uniw -Direct 000 222.1 Evidence Based Program-SFP Grad Supplies Education Un-e -Direct 0.00 0.00 0.00 000 1271 Training- CADCA MEMBERSHIP-Ouinoy Other Universal-Direct 0.00 0.00 0 00 0.00 0.00 0 00 0.00 0D 0.00 0.00 0.00 0 00 000 0.00 0 00 000 000 0.00 0.00 000 0.00 0.00 000 0 00 1.146.29 om 0.00 0.00 o.ao 000 0.00 0.00 am -OXI 0.00 1 0.00 1,146.29 PREPARED BYI OATF Reyro Cowles 06123/2020 TELEPHONE 509 784-2660 A19 Effective 711119 through 6/30/21 REVISED 112112020 CURB DOC NO DOC DATE VENDOR NO. SWV0002426-00 AGENCY APPROVAL: Sarah Mariani, 360-725-9401, Sarah.Mariani hcama. oV ACCOUNTING APPROVAL FOR PAYMENTI DATE