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35 <br /> <br />Attachment 4 <br /> <br />Participating Entities & Facility Locations <br />Please complete this Attachment if your organization has control over Participating Entities as defined in Section 2.37 that your organization is signing the <br />agreement and submitting HIE Data on behalf of. Please include information for all facility locations that are a part of your organization. Please only <br />provide the organization NPI for your Participating Entities or facilities, do not list individual provider NPIs. If you need more space, please attach a <br />separate document, e.g. an Excel spreadsheet, labeled “Attachment 4” to this Agreement with the information requested below. <br /> <br /> Legal Entity Name Address Organization NPI Participant Account <br />Administrator Email Phone <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />10 <br />DocuSign Envelope ID: 47B4445A-C7CA-4D2E-9075-2AFD82F82DEC