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ffi,ALTHPLAITI: <br />Coordinated Care <br />Authorized Signature: <br />Inc. <br />v{fu*, <br />PrintName: Beth Johnson <br />Tifle: Plan President & CEO <br />Signature Datr; 0812012025 <br />ICM #: ICMProviderAgeement_360268 <br />To h complcted by IIeaIth Plrn only: <br />EffectiveDate: O74B2O2S <br />PPA WA - Kifiitas County Public I'Iealth - A5,A7 2M5 - ICMProviderAgreement 360258 Page 18 of24