OHIO DEPARTMENT OF MEDICAIDProvider Enrollment Agreement • January 18th, 2022
This provider agreement is a contract between the Ohio Department of Medicaid (the Department) and the undersigned provider of medical assistance services in which the Provider agrees to comply with the terms of this provider agreement, Ohio statutes, Ohio Administrative Code rules, and Federal statutes and rules, and agrees and certifies to:
PROVIDER ENROLLMENT AGREEMENTProvider Enrollment Agreement • September 1st, 2009
CMAP Express is a non-profit Central Fill Pharmacy which has acquired contracts with several drug manufacturers to provide us with bulk donation medications. These contracts allow CMAP Express to offer free medications to your patients who meet certain guidelines.
PROVIDER ENROLLMENT AGREEMENT TERMS OF AGREEMENTProvider Enrollment Agreement • August 28th, 2018 • Michigan
This Agreement is between _________________, hereinafter referred to as “Provider,” and Region B3 Area Agency on Aging DBA CareWell Services SW, 200 W. Michigan Ave, Suite 102, Battle Creek, MI 49017, herein referred to as “Waiver Agent.”
PROVIDER ENROLLMENT AGREEMENTProvider Enrollment Agreement • March 14th, 2016
This Agreement sets forth the conditions for being enrolled with the Department of Human Services (DHS) to provide Consultant services (hereinafter referred to as “Provider”) and to receive a provider number in order to submit payment claims, and to receive payment for services to developmentally disabled clients of Community Developmental Disability Programs or Brokerages. Payments for services are made using federal Medicaid funds, or State of Oregon funds, or a combination of both state and federal funds.
PROVIDER ENROLLMENT AGREEMENTProvider Enrollment Agreement • February 5th, 2018
This 340 B Program Addendum (“Addendum”) is made between the State of Vermont, Department of Vermont Health Access (“DVHA”) and (“340B Partner”) and incorporated into the Provider Enrollment Agreement between them dated (“Provider Agreement”). This Addendum shall replace and supersede in their entirety all prior 340B Program amendments, addenda or other 340B Program-specific attachments or modifications to the Provider Agreement.
PROVIDER ENROLLMENT AGREEMENT 340B AMENDMENTProvider Enrollment Agreement • March 26th, 2015
This amendment complies with the requirements of 42 C.F.R. 438.6 that require a Medicaid MCO (Managed Care Organization) to have contracts with its provider network.
OHIO DEPARTMENT OF MEDICAIDProvider Enrollment Agreement • April 8th, 2022
This provider agreement is a contract between the Ohio Department of Medicaid (the Department) and the undersigned provider of medical assistance services in which the Provider agrees to comply with the terms of this provider agreement, Ohio statutes, Ohio Administrative Code rules, and Federal statutes and rules, and agrees and certifies to:
PROVIDER ENROLLMENT AGREEMENTProvider Enrollment Agreement • October 21st, 2020 • Michigan
THIS AGREEMENT is entered into between and hereinafter referred to as “Provider,” and Region IV Area Agency on Aging, Inc., 2900 Lakeview Avenue, St. Joseph, Michigan 49085, herein referred to as “Area Agency on Aging” or “AAA.”
PROVIDER ENROLLMENT AGREEMENTProvider Enrollment Agreement • November 23rd, 2007
(hereinafter “Provider”) wishes to participate in the Connecticut Medical Assistance Program and, therefore, represents and agrees as follows:
