State Designation definition
Examples of State Designation in a sentence
It is not the intent of this Agreement to alter CRISP’s right to negotiate such Participation Agreements provided that they are consistent with this State Designation Agreement and CRISP’s obligations as the State-Designated HIE.
This Agreement follows upon and replaces the April 2016 State Designation Agreement.
Sign: Print Name: Title: ADDRESS: License No. Issuing State: Designation / Classification: #10414391_v2 APPOINTMENT APPLICATION Health License Number: Name D.O.B. S.S# Resident Address Phone Business Address Phone Please send mail to: □ Residence □ Business Name of Insurance Company(ies) you represent.
In acknowledgement of the aforementioned, the duly authorized officials of CRISP and MHCC do hereby enter into this State Designation Agreement.