Medicare Opt Out and Waiver Agreement Sample Contracts
MEDICARE OPT OUT AND WAIVER AGREEMENTMedicare Opt Out and Waiver Agreement • October 29th, 2018
This agreement (Agreement) is entered into by and between DOMINION PRIMARY CARE, PLLC, a Texas Professional Limited Liability Company, Dr. Chrissy Navejar (Physician), whose principal address is 23535 W IH 10, Suite 2205, San Antonio, Texas 78257 and
MEDICARE OPT OUT AND WAIVER AGREEMENTMedicare Opt Out and Waiver Agreement • April 25th, 2022
This agreement (Agreement) is entered into by and between Camino Clinic ,whose mailing address is 133 Stetson Drive, Charlotte, North Carolina 28262, and ,
MEDICARE OPT OUT AND WAIVER AGREEMENTMedicare Opt Out and Waiver Agreement • May 31st, 2021
This agreement (Agreement) is entered into by and between LiveActive Primary Care, PLLC, a Kansas Limited Liability Company, Dr. Haseeb Ahmed, (Physician), whose principal address is 7199 West 98th Terrace, Suite 110, Overland Park, KS 66212, and , a beneficiary enrolled in Medicare Part B pursuant to Section 4507 of the Balanced Budget Act of 1997 (“Beneficiary”), who resides at