AUTHORIZED PROVIDER. 17.1 PROVIDER STATUS On the effective date of the agreement, DHA recognizes the IOP as an authorized provider for the purpose of providing intensive outpatient care to eligible beneficiaries within the framework of the program(s) identified below. INTENSIVE OUTPATIENT PROGRAM (IOP) NAME(S) CAPACITY AGE RANGE DAYS OF OPERATION Intensive Outpatient Program (IOP) Facility Name Expiration Date DHA By: Signature By: Signature Name and Title Name and Title Executed on: Executed on:
Appears in 18 contracts
Samples: Participation Agreement, Participation Agreement, Participation Agreement
AUTHORIZED PROVIDER. 17.1 PROVIDER STATUS On the effective date of the agreement, DHA recognizes the IOP as an authorized provider for the purpose of providing intensive outpatient care to eligible beneficiaries within the framework of the program(s) identified below. INTENSIVE OUTPATIENT PROGRAM (IOP) NAME(S) CAPACITY AGE RANGE DAYS OF OPERATION Intensive Outpatient Program (IOP) Facility Name Expiration Date DHA By: Signature By: Signature Name and Title Name and Title Executed on: Executed on:
Appears in 5 contracts
Samples: Participation Agreement, Participation Agreement, Participation Agreement
