HomeMy WebLinkAboutInvoices - Renew (002)State of Washington
Invoice Voucher
Health Care Authority
621 8th Avenue SE
Olympia, WA 98504
EME61
ILI
Vendor's Certiffic �e. I hereby certify under penalty of perjury that the Items and totals listed herein are proper charges for materials, merchandise or
f'c
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services fufrshle X, r State of Wqshington, and YVt all good; furnished and/or services rendered have been provided without discrimination
because o age, s , State of �ce, creed, ccloiinational origin, handicap, religion, or Vietnam era or disabled veterans status.
Grant County
840 E Plum St
Moses Lake, WA 98837
BY 1 � 1.1 12a. WIN 11 1 M
(slan in ink)
Cindy Carter, B CC Chair DU7
(title) (date)
TAX IDENTIFICATION NUMBER
319
MONTHNEAR OF SERVICE (MMNYYY) RECEIVED BY
Oct -21
DATE RECEIVED
I kyl I CA Z F.3 I
II 1
Admin I Indirect
�,Community-Based
Coordination-Px Community -Based Process
'Community Coalition Coordinator -Based Process
Community
Community Coalition Community -Based Process
Information Dissemination
Information Dissemination
Information Dissemination
Information Dissemination
-Alternatives
Alternatives
Alternatives
Alternatives
Problem Identification & Referral
MINN �0_
Problem Identification & Referral
Problem Identification & Referral
Problem Identification & Referral
Community Coalition- Community -Based Process
'Community Coalition- Start-up Costs Community -Based Process
Community -Based Process
Community -Based Process
Environmental
Environmental ---
Environmental
Environmental
PREPARED BY/ DATE TELEPHONE
Reyna Gonzales 1111612021 509 7642660 A19 Effective 711/2021 through 6130/2023 REVISED 7/2021
CURR DOC NO DOC DATE VENDOR NO. AGENCY APPROVAL:
SWV0002426-00 Sarah Mariani, 360-725-9401, Sarah.Mariani@hca.wa.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
. . . . . . . . . . . .
r.
Consent Agenda Week
Week of 12/6/2021
Item
A-19
Entity/Contracted Business
Health Care Authority
Contract Number
K5536 (Prevention)
Confidential
No
Description
This is an A-19 for Prevention in Soap Lake for the month of October 2021.
The amount is $81426.84
Original Needed?
Yes, please email scanned copy and inner -office original
Copies Attached
Two
Contact for Questions
Reyna Gonzales,, Extension 5433
V E D
2.021
"UU N,