NBM ---------------------------- INFORMATION TECHNOLOGY, INC.Services Provider Agreement • June 28th, 2002 • Humana Trans Services Group LTD • New York
PHARMACY SERVICES PROVIDER AGREEMENTServices Provider Agreement • May 12th, 2020
Consent to Provide Services and Medical Records PLEASEATTACHI, , authorize Heartland Pharmacy, and any other pharmacy owned by PharmEase, COPIES OFLLC (referred to this agreement as the “Pharmacy”) to provide medications and associated products and services to the above named Patient. If signing FRONT AND this Agreement as an agent of the Patient pursuant to a Power of Attorney (POA). I certify that I have the legal authority to sign this agreement. I certify BACK OF that the Facility/Organization listed above has in their possession and may provide the pharmacy with the most current and accurate medical records for PATIENT’S the above listed patient. I also permit for the above facility to notify the pharmacy of any medical changes and records to the above patient. INSURANCECARDSAssignment of Benefits and Privacy Practices REMINDER: MostI hereby request that payment of authorized insurance benefits be made on the Patient’s or my behalf to the Pharmacy for medications, products and/or
SERVICES PROVIDER AGREEMENTServices Provider Agreement • August 5th, 2022 • California
This Services Provider Agreement (together with all amendments, addenda and exhibits attached hereto, the “Agreement”) is made as of the Effective Date written below by and between {Insert Local Oracle Subsidiary name} (“Oracle”), with offices located at {Insert Local Oracle Subsidiary address}, and INSERT LEGAL NAME OF PROVIDER ENTITY EXECUTING SPA (“Provider”) with offices located at INSERT ADDRESS OF PROVIDER. For purposes of this Agreement, Oracle’s subsidiaries, parent companies and other affiliates are each individually referred to herein as an “Oracle Affiliate” and collectively as the “Oracle Affiliates”.
SERVICES PROVIDER AGREEMENTServices Provider Agreement • April 18th, 2023
with an address at 625 Celeste Street, STE104, New Orleans, Louisiana, 70130 and Polywrap Foundation, a Cayman Islands foundation company (the “Client”).
Child Care Services Provider AgreementServices Provider Agreement • October 11th, 2022
Child Care Regulation Licensing No: EIN/Social Security No: Name of Facility: Type of Facility: Licensed Center Licensed Home Registered Home Partnership site: ☐ Pre-K (ISD/Charter: ) ☐ Head Start ☐ Early Head Start Address of Facility (Street, City, State, Zip): Facility Phone Number: Facility Email: Mailing/Billing Address (Street, City, State, Zip): Contact Person: Title: Contact Person Phone Number: Contact Person Email:
Services Provider AgreementServices Provider Agreement • May 2nd, 2013 • California
THIS AGREEMENT, entered into this 1st day of July, 2013, by and between CITY OF ALAMEDA, a municipal corporation (hereinafter referred to as "City"), and MV TRANSPORTATION, INC., a California corporation, whose address is 2024 COLLEGE STREET, ELK HORN, IOWA 51531, hereinafter referred to as the Provider, in reference to the following:
HOMEMAKER/PERSONAL CARE/NON-HOMEMAKER SERVICES PROVIDER AGREEMENTServices Provider Agreement • February 27th, 2024
This Agreement is entered into by and between WestMass ElderCare Inc. the Aging Services Access Point (ASAP), a Massachusetts non-profit corporation having its principal offices located at 4 Valley Mill Road, Holyoke, MA. 01040 and Provider name , the Provider, with its principal offices at address
TO THE 911 EMERGENCY MEDICAL SERVICES PROVIDER AGREEMENT BETWEEN THE CITY OF MILPITAS AND THE COUNTY OF SANTA CLARAServices Provider Agreement • May 19th, 2016
This Second Amendment to the 911 Emergency Medical Services Provider Agreement (“Second Amendment”) is entered into by and between the City of Milpitas (“Provider”) and the County of Santa Clara (“County”), effective as of June 30, 2016 (“Effective Date”).
TRAVEL SERVICES PROVIDER AGREEMENT WITH Program ProviderServices Provider Agreement • September 14th, 2023
This Agreement is entered into by and between the San Mateo County Community College District, a public educational agency (hereinafter called "District") and Program Provider, having its legal address at
PHARMACY SERVICES PROVIDER AGREEMENTServices Provider Agreement • September 20th, 2017
I, , authorize Heartland Pharmacy, and any other pharmacies owned by PharmEase, LLC (referred to in this agreement as the “Pharmacy”) to provide medications and associated products and services to the above named Patient. I certify that I have the legal authority to sign this agreement on behalf of said Patient and I understand that by signing this agreement I will become responsible to pay the usual and customary fee for all medications, products and services provided to the Patient by the Pharmacy at the direction of the facility administration and staff and attending physician(s). If I disagree with any medication, product or service directed by the facility or an attending physician, I will contact them and resolve the issue(s) and ask them to provide different written direction to the Pharmacy. I acknowledge and agree that the Pharmacy provides medications, products or services based upon the most current written direction received by it.
COMMUNICATIONS VOICE AND DATA SERVICES PROVIDER AGREEMENTServices Provider Agreement • August 17th, 2007 • Cardionet Inc • California
This Communications Voice and Data Services Provider Agreement (the "Agreement") is entered into as of May 12, 2003 (the "Effective Date"), by and between QUALCOMM Incorporated, a Delaware corporation ("QUALCOMM") with its principal place of business located at 5775 Morehouse Drive, San Diego, CA 92121-1714, and CardioNet, Inc., a California corporation ("CardioNet") with its principal place of business located at 510 Market Street, San Diego, CA 92101, with respect to the following facts:
Amendment No. 8 To Communications Voice and Data Services Provider AgreementServices Provider Agreement • December 5th, 2011 • CardioNet, Inc. • Surgical & medical instruments & apparatus
This Amendment No. 8 to the Communication Voice and Data Services Provider Agreement dated May 12, 2003, as amended (“Amendment” or “Amendment No. 8”) is entered into as of November 30, 2011 (“Amendment Effective Date”) by and between nPhase, LLC, a Delaware limited liability company (“nPhase”) and CardioNet, Inc., a Delaware corporation (“CardioNet”), with respect to the following facts:
TO THE 911 EMERGENCY MEDICAL SERVICES PROVIDER AGREEMENT BETWEEN THE CITY OF MILPITAS AND THE COUNTY OF SANTA CLARAServices Provider Agreement • August 18th, 2016
This Third Amendment to the 911 Emergency Medical Services Provider Agreement (“Third Amendment”) is entered into by and between the City of Milpitas (“Provider”) and the County of Santa Clara (“County”), effective as of November 1, 2016 (“Effective Date”).
FOURTH AMENDMENT TO THAT 2012 HOME SERVICES PROVIDER AGREEMENTServices Provider Agreement • March 31st, 2014 • Goodman Networks Inc • Radiotelephone communications
This Fourth Amendment (the “Fourth Amendment”) to that certain DIRECTV, Inc. 2012 Home Services Provider Agreement dated May 1, 2011 (the “Agreement”) by and Multiband Field Services, Inc. (“Contractor”), and DIRECTV, LLC (“DIRECTV”), is hereby made and entered into this eleventh (11th) day of October, 2013 (the “Fourth Amendment Effective Date”), as follows:
DIRECTV, INC. 2007 HOME SERVICES PROVIDER AGREEMENTServices Provider Agreement • March 31st, 2008 • 180 Connect Inc. • Electrical work • California
This Home Services Provider Agreement (including all Exhibits and Schedules hereto, this “Agreement”) is entered into this first (15t) day of May, 2007 (the “Effective Date”), between DIRECTV, Inc., a California corporation (“DIRECTV”), and Mountain Satellite, Inc. (“Contractor”). DIRECTV and Contractor may also be collectively referred to herein as the “Parties.”
TO THE 911 EMERGENCY MEDICAL SERVICES PROVIDER AGREEMENT BETWEEN THE CITY OF SAN JOSE AND THE COUNTY OF SANTA CLARAServices Provider Agreement • December 15th, 2014
This Second Amendment to the 911 Emergency Medical Services Provider Agreement (“Second Amendment”) is entered into by and between the City of San Jose (“Provider”) and the County of Santa Clara (“County”), effective on the last signature date set forth below (“Effective Date”).
Payment Services Provider AgreementServices Provider Agreement • April 14th, 2015 • Shopify Inc. • Services-prepackaged software • California
This Payment Services Provider Agreement (“Agreement”) is entered into as of July 22, 2013 (the “Effective Date”) between Stripe, Inc., a Delaware corporation with offices at 3180 18th Street, Suite 100, San Francisco CA 94110 (“Stripe”) and Shopify Payments (USA) Inc., a Delaware corporation with offices at c/o CT Corporation, Corporation Trust Centre, 1209 Orange Street, Wilmington Delaware 19801 USA (“Shopify USA”). Stripe and Shopify USA may be collectively referred to herein as the “Parties” and each as a “Party”.
PREAMBLEServices Provider Agreement • March 25th, 2002 • Transgenomic Inc • Laboratory analytical instruments • New York
Amendment No. 6 To Communications Voice and Data Services Provider AgreementServices Provider Agreement • July 22nd, 2008 • Cardionet Inc • Surgical & medical instruments & apparatus
This Amendment No. 6 to the Communication Voice and Data Services Provider Agreement dated May 12. 2003, as amended ("Amendment") is entered into as of June 26, 2008 ("Amendment Effective Date") by and between QUALCOMM Incorporated, a Delaware corporation ("Qualcomm") and CardioNet, Inc., a California corporation ("CardioNet"), with respect to the following facts:
