HomeMy WebLinkAboutAgreements/Contracts - RenewIN WITNESS WHEREOF, the Parties hereto have executed this Agreement, * clu
on Sc , effecti in ding all Product Attachments noted
Ledule B ve as of the date set forth beneath their respective signatures.
.HLALTHPLAT:
Coordinated Care Corporation
Authon*zed Signature.
Print Name: Beth Johnson
Title: CEO
Signature Date: 05/16/2023
To be completed by Real h Plan onl
ya
Effective Date: 10/10/2022
k R.Q V I D E R.b
,Grant County dba Renew
'(Legibly P i t Name of Provi
rM Te r)
Authorized Signature:
ooz
PnirltName: Danny E,Ston
/
BOCC. Chair
Title-,
- Oz
Signature Date: 312 2—
Tax Identification Number: 91-6001319,
State Medicaid Number:.
PPA WA County ofGrant dba Grant IntegratedServices-071422581054 Page 16 of 24