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PARTICIPATING PROVIDER AGREEMINT <br />SCHE,DULEB <br />PRODUCT PARTICTPATION <br />Provider and Contracted Providers will be subject to and bound by the Attachments set forth below, and designated <br />as a'?articipating Provider" in the Products set forth below as of the date of suocessful completion of credentialing <br />in accordance with this Agreement. <br />List of Product Attachments and Addenda: <br />Attacbment A: Medicaid <br />Attachment A-1 : [Reserved] <br />AddendunA: [Reserved] <br />AddendumB: fReserved] <br />Acldendrim C: fReserved] <br />Attachment B: fReserved] <br />Attaobment C: [Reserved] <br />Attachment D: [Reserved] <br />Attachment E: [Reserved] <br />Attachment F: [Reserved] <br />Attacbment G: [Reserved] <br />List of Schedules: <br />Schedule A Contracted Provider-Specific Provisions <br />Schedule B Product Participation <br />Scheclule C Inforrration For Contracted Providers <br />Schedule D-l [Reserved] <br />Sohedule D-2 [Reservecl] <br />Health PIan to which Product Attachments Apply: <br />On at least 60 days' advance written notice (written or electronic), CCC and CCW may jointly noti$ Provider that <br />an Attachment shall no longer be a Product of CCC and shall be a Product of CCW on the date specified in the notice. <br />As of zuch date, the designated Attachment(s) shall terminate with respect to CCC as the Health Plan and comrnenoe <br />with respect to CCW as the t{ealth Plan for zuch Product. <br />PPA WA - Kittitas County Public llealth - A5.07.2025 - ICMProviderAgreernent 360268 Page23 of24