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IN WITNESS WHEREOF, the Parties hereto have executed this Agreement, including all Product Attachments <br />noted on Schedule B, effective as of the date set forth beneath on their respective signatures. <br />HEALTH PLAN: <br />PROVIDER: <br />Coordinated Care Corporation Kittitas County Sheriff's Office <br />(Legibly Print Name of Provider) <br />Authorized Signature: <br />Print Name: Beth Johnson <br />Title: Plan President & CEO <br />Signature Date: <br />Authorized Signature: <br />Print Name: <br />GMy ^YE2S <br />Title: <br />Signature Date: <br />Gw� <br />Tax Identification Number: 91-6001349 <br />Medicare Number: <br />Signature Block Continues on Next Page <br />PPA WA - Kittitas County Public Health - 05,07.2025 - ICMProviderAgreement_360268 Page 17 of 24 <br />