RFP 2025HCA15 Exhibit B Draft Contract

Description

CONTRACT for Mail Order Incontinence and Urinary Supplies and Services HCA Contract Number: K Resulting from Solicitation Number (If applicable): Contractor/Vendor Contract Number: THIS CONTRACT is made by and between the Washington State Health Care Authority, (HCA) and (Contractor). CONTRACTOR NAME CONTRACTOR ADDRESS , CONTRACTOR DOING BUSINESS AS (DBA) Street CONTRACTOR CONTACT City State CONTRACTOR TELEPHONE Zip Code CONTRACTOR E-MAIL ADDRESS Is Contractor a Subrecipient under this Contract? YES NO HCA PROGRAM HCA DIVISION/SECTION HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESS Health Care Authority 626 8th Avenue SE P.O. Box ____ Olympia, WA 98504-____ , HCA CONTACT TELEPHONE HCA CONTACT E-MAIL ADDRESS 360-725CONTRACT START DATE CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT October 1, 2026 TBD No Maximum PURPOSE OF CONTRACT: The parties signing below warrant that they have read and understand this Contract and have authority to execute this Contract. This Contract will only be binding upon signature by both parties. The parties may execute this contract in multiple counterparts, each of which is deemed an original and all of which constitute only one agreement. E-mail (electronic mail) transmission of a signed copy of this contract shall be the same as delivery of an original. CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED HCA SIGNATURE PRINTED NAME AND TITLE DATE SIGNED Rev 10.2024 TABLE OF CONTENTS 1. Statement of Work (SOW)............................................................................................................4 2. Definitions ....................................................................................................................................4 3.