HomeMy WebLinkAboutInvoices - RenewForm State of Washington
PIR
1070 K3919
A19 -1A Invoice Voucher
. -A COO W
Health Care Authority
621 8th Avenue SE
Vendor's Certificate. hereby certify under penalty o perjury that the items and totals listed herein are proper charges for materials, merchandise or
Olympia, WA 98504
services furnlspadlQ the State of Washingtq and that 39 goods furnished and/or services rendered have been provided without discrimination because
of age, sexViTwital sta r e, creed, coltr-�!�
tational c I in, handicap, religion, or Vietnam era or disabled veterans status.
BY
Grant County
hzifin in inkl
840 E Plum St
Moses Lake, WA 98837
Cindy Carter, BOCC Chair L
(title) (date)
TAX IDENTIFICATION NUMBER
MONTH/YEAR OF SERVICE (MMlYYYY)
RECEIVED BY
DATE RECEIVED
*1319
Aug -21
-P SAB SAB ZOVIDft
BP _7 1iMHDP
-7
11.1 Admin I IMirect
236.28 581.38 13.90
831.76
21 Community -Based Coordination-Px Community -Based Process
Universal -Indirect
0.00
22,5 Community Coalition Coordinator Community -Based Process
Universal -Direct
0.00
22.5 Community Coalition Community -Based Process
Universal -Direct
0.01)
7 7-
77' 77;
22.5,1 Community Coalition Coordinator -ML Community -Based Process
Universal -Direct
6,073.43
6,073.43.
22.5.1 Community Coaltlon- ML- Community -Based Process
Universal-Dirwt
0.00
22.1.2 PAX -Good Behavior Game - ML Information Dissemination
Universal -Indirect
0.00
22.2.1 Strengthening Families Program- ML Education
Universal -Direct
0.00
22.2.1 Youth Empowerment -ML Education
Universal-Direct
0.00
22.1.2 Outreach & Education- ML- Information Dissemination
Universakindirect
123.55
123.55
22,1.2 Talk. They Hear You -ML Information Dissemination
Universal -Indirect
0.00
22.1,2 Under the Influence of You- ML Information Dissemination
Universal -Indirect
0.00
22.1.2 You Can- ML Information Dissemination
Universal -Indirect
0.00
22.6.2 Enviornmental Strategy- ML Environmental
Universal -Indirect
0.00
22.7.1 Coalition/Community Training -ML- Other
Universal -Direct
0.00
22.7.1 Community Education Workshops- ML Other
Universal -Direct
0.00
22,7.1 Coordinator Professional Development -ML Other
Universal -Direct
0.00
22.5.1 Community -Based Process
Universal -Direct
0.00
22.5.1 Community, -Based Process
Universal -Direct
0.00
22,51 Community Coalition Coordinator- Q Community -Based Process
Universal -Direct
2,412.55
2,412.55
22.5.1 Community Coaltion- Q- supplies Community -Based Process
Universal -Direct
173.82
173.82
22.1.1 Youth Development -Q Information Dissemination
Universal -Direct
0.00
22.1.2 YOU Can- Q Information Dissemination
Universal -Indirect
0.00
22.1,2 Under the Influence of You- Q Information Dissemination
Universal -Indirect
0.00
22.1.2 RX Safe Disposal Information Dissemination
Universal -Indirect
0.00
-.22.1.2 Starts With One - Q Information Dissemination
Universal -Indirect
0.00
22.2.1 Strengthening Families Program- Q Education
Universal -Direct
0.00
22.2.1 SPORT PPW-Q- Program Start-up Cost Education
Universal -Direct
541.00
541.00
22.3.1 Healthy Alternatives- Q Alternatives
Universal -Direct
0100
- 22.6.2 Drug Free Park- Q Environmental
Universal -Indirect
0.00
22.6.2 QHS Disciplinary - Q Environmental
Universal -Indirect
0.00
- 22.6.2 Px Sustainability P0IIGyQ Environmental
Universal -Indirect
0.00
22,7.1 ICoordinator Professional Development -Q Other
Universal -Direct
0.00
- 22.7.1 Coalition/Community Training -Q Other
Universal -Direct
0.00
22.1.1 Community Education Workshops - Q Information Dissemination
Universal -Direct
0.00
0.00
-
0.00
0.00
0.00
0100
0.00
0.00
0100
0.00
�60 81 87.77 _6,0 _6
10
,
PREPARED BY/ DATE
Reyna Gonzales 10119121
TELEPHONE
509 764-2660
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2
CURB DOC NO
DOC DATE
VENDOR NO.
I SWV0002426-00
JAGENCYAPPROVAL:
Sarah Marian!, 360-725-9401, Sarah.Mariani@hca.wa.gov
ACCOUNTING APPROVAL FOR PAYMENT/ DATE
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NOV - 5 2021
G F-3 AT rnU UNITY CflI
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Grant Behavioral Health 6 Wellness
840 E. Plum Street
Moses Lake, WA 98837
Phone: (509) 765-9239
Fax: (509) 765-1582
Consent Agenda Week Week of 11/8/21
Item A-19
Entity/Contracted Business Health Care Authority
Contract Number K3919 (Prevention)
Confidential No
Description This is an A-19 for Prevention in Moses Lake and Quincy for the month of
August 2021. The tentative amount is
Original Needed? Yes, please email scanned copy and inner -office original
Copies Attached This will be emailed by Friday.
Contact for Questions Reyna Gonzales,, Extension 5433