Molina Medicaid Solutions - DHHR

exv10w245.10 Notice. All notices required or permitted by this Agreement shall be in writing and may be delivered in person or may be sent by registeredor certified mail or U.S. Postal Service Express Mail, with postage prepaid, or by Federal Express or other overnight courier that guaranteesnext day delivery, or by facsimile transmission, and shall be deemed sufficiently given if served in the manner specified in this Section. Theaddresses below shall be the particular party’s address for delivery or mailing of notice purposes:If to Health Plan:Molina Healthcare of California200 Oceangate, Suite 100, Long Beach, California, 90802Attention: President/CEOIf to Provider:Pacific Hospital of Long BeachAttention: Michael D Drobot, CEOThe parties may change the names and addresses noted above through written notice in compliance with this Section. Any notice sent byregistered or certified mail, return receipt requested, shall be deemed given on the date of delivery shown on the receipt card, or if no deliverydate is shown, the postmark date. Notices delivered by U.S. Postal Service Express mail, Federal Express or overnight courier that guaranteesnext day delivery shall be deemed given twenty-four (24) hours after delivery of the notice to the United States Postal Service, FederalExpress or overnight courier. If any notice is transmitted by facsimile transmission or similar means, the notice shall be deemed served ordelivered upon telephone confirmation of receipt of the transmission, provided a copy is also delivered via delivery or mail.*** THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK ***HSA — Hospital Services AgreementMolina ECMS ref# 729 Provider or authorizedMHC v122706 / MHI v091707 representative’s initials:Pacific Hospital of Long BeachPage 17 of 40SIGNATURE AUTHORIZATIONIN WITNESS WHEREOF, the parties hereto have agreed to and executed this Agreement by their officers thereunto duly authorized as of theEffective Date set forth by Health Plan below. The individual signing below on behalf of Provider acknowledges, warrants, and represents that saidindividual has the authority and proper authorization to execute this Agreement on behalf of Provider and its constituent providers, if any, and doesso freely with the intent to fully bind Provider, and its constituent providers, if any, to the provisions of this Agreement.Pacific Hospital of Long Beach Molina Healthcare of CaliforniaProvider MolinaSignature: /s/ M. Drobot Signature: /s/ Lisa RubinoSignatory Name M. Drobot Signatory Name Lisa Rubino(Printed): (Printed):Signatory Title Signatory Title President(Printed): CEO (Printed):Signature Date: 4/16/09 Signature Date: 4/30/09Effective Date: (To be completed by Health Plan)http://sec.gov/Archives/edgar/data/1179929/000095012310025132/a55407exv10w24.htm[1/6/2012 11:13:06 AM]