HomeMy WebLinkAboutInvoices - Renew (003)Form State of Washington
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Health Care Authority
621 8th Avenue SE
Olympia, WA 98504
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Grant County
840 E Plum St
Moses Lake, WA 98837
TAX IDENTIFICATION NUMBER MONTHNEAR OF SERVICE (MMIYYYY) RECEIVED BY
319 1 Ser) -21
1070 K5536
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undera "uythattheitems and totals "sled
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in are proper charges for material
s, merchandise or sns9to0fEa 1ng and that (goods furnished and/or sericesrendered have been provided without discriminationbe ause as tpisIaI, race,color,'nal origin, handicap,
religionr Vietnam era or disabled veterans status.
(sign in ink)
Cindy Carter, BOCC Chair
1.-q 7,14
(title) (date)
DATE RECEIVED
NOV .. 5 2021
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GRANT COUNTY C,01,,j%11S SION Er% 3
—Community
Commurwty�Basad Prccess
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Coalition Coordinator
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Information Dissemination
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information 01sumination
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Education
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Education
Education
Education
Universal -Indirect
Alternatives
Problem Identification & Referral
Problem Identification & Referral
;Community Coalition -Program Start-up Cof
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PREPARED BY/ DATE
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Reyna Gonzales 11/03/2021
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;AGVNCY APPROVAL-
SWV0002426-00
Sarah Marian!, 360-725-9401, Sarah.Mariani@hca.wa.gov
NOV .. 5 2021
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GRANT COUNTY C,01,,j%11S SION Er% 3
Consent Agenda Week Week of 11/8/21
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 September 2021.
The tentative amount is $14-,000. (31 S7j7 ,. 0 S
/5/'
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