Common Contracts
2 similar Provider Agreement contracts
PROVIDER AGREEMENTProvider Agreement • June 2nd, 2014
By execution of this Agreement, the undersigned entity (“Provider”) requests enrollment as a provider of services or supplies to participants in one of Indiana's Medicaid-approved Community-Based Options for Youth and Families Wraparound Services Programs. The federally-and/or State-funded Home and Community-Based Service programs (hereinafter, "HCBS") are authorized by Medicaid. As a condition of enrollment, Provider agrees:
INDIANA DIVISION OF MENTAL HEALTH & ADDICITION YOUTH SERVICES HOME & COMMUNITY- BASED WRAPAROUND SERVICESProvider Agreement • June 2nd, 2014
By execution of this Agreement, the undersigned entity (“Provider”) requests enrollment as a provider of services or supplies to participants in one of Indiana's Medicaid-approved Community-Based Options for Youth and Families Wraparound Services Programs. The federally-and/or State-funded Home and Community-Based Service programs (hereinafter, "HCBS") are authorized by Medicaid. As a condition of enrollment, Provider agrees:
