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STATE OF FLORIDA <br />INDIAN ER COUNTY <br />Advanced Platinum PPO THIS ERTIFY THAT THIS IS E AND C RRECT <br />COP E ORIGINALON FILE N TH 8 OFFIC <br />EFFR R?S I K <br />Medical: $34.14 BY !j D.C. <br />DATE <br />Rx: $212.28 <br />D/V/H: $7.00 <br />Fitness: $4.00 <br />TOTAL: $257.42 pmpm <br />The Group's Agreement is effective as of October 1, 2021 <br />IN WITNESS WHEREOF, the parties have executed this Agreement as of October 1, 2021 <br />Blue Cross Blue Shield of Florida, Inc. <br />(DBA Florida Blue) <br />(Signature) <br />Indian River Board of County Commissioners <br />SS <br />By: c": <br />?i'gn`a4e-re) <br />Name: Kevin Kenney Name: <br />(Please Print or Type) <br />Title: Vice President, Medicare Business Title: <br />Performance and Integration <br />Attest. Jeffrey R. Smith, Clerk of <br />Cit and C troller <br />Deputy Clock <br />12 <br />Joseph E. Flescher <br />(Please Print or Type)Chran <br />°°w corvtM • <br />• q Oui Tv. `-.. <br />BY v i ` ..-......... .,. -.. moi..; . `'•i i Y :+: teD <br />