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IN WITIIESS WHEREOF, the Parties hereto have executed this Agreement, including all Product Attachments <br />noted on Schedule B, effective as ofthe date set forth beneath on their respective signatures. <br />TIEALTH PLAI{: PROVIDER: <br />Coordinated Care Comoration Kittitas Sheriffs Office <br />(Legibly PrintName of Provider) <br />Authorized Signature:Authorized Signature: <br />6{fu*, <br />Print Name: Beth Johnson <br />Title: PIan President & CEO <br />Signature Date: 0812012025 <br />Print Name <br />T r'IY6R5 <br />Title: <br />St{Enr er <br />Signature Date <br />6-?-tr <br />Tax ldentification Number: 91-6001349 <br />Medicare Number: <br />Signature Black Continues on N*t Page <br />PPA wA - Kinitas county Public Health - 05.07.2025 - ICMprov'derAgreementJ6026g Page I 7 of24