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<br /> <br /> Page 14 of 48 <br />THIS AGREEMENT CONTAINS A BINDING ARBITRATION PROVISION <br />THAT MAY BE ENFORCED BY THE PARTIES. <br /> <br />IN WITNESS WHEREOF, the Parties hereto have executed this Agreement, including all Product Attachments <br />noted on Schedule B, effective as of the date set forth beneath their respective signatures. <br /> <br />WELLCARE: PROVIDER: <br /> <br />WellCare Health Plans, Inc. <br /> (Legibly Print Name of Provider) <br /> <br />Authorized Signature: <br /> <br /> <br /> <br /> Authorized Signature: <br /> <br /> <br /> <br /> <br />Print Name: Troy Hildreth Print Name: <br /> <br />Title: State President Title: <br /> <br />Signature Date: Signature Date: <br /> <br />ICM #: Tax Identification Number: <br /> <br /> State Medicaid Number: <br /> <br />To be completed by WellCare only: National Provider Identifier: <br /> <br />Effective Date: <br /> <br /> <br /> <br />DocuSign Envelope ID: 2EC1F0FD-FAF9-4B42-B52E-D419F55A6210 <br />56-6000327 <br />1629178629 <br />3406929 <br />6/30/2021 <br />157444 <br />Orange County NC <br />Bonnie Hammersley <br />County Manager <br />7/1/2021