Common use of Agreement to Provide Clause in Contracts

Agreement to Provide. Supply and pharmaceutical care as defined in the SLA and the Service Outline – Additional Pharmaceutical Services – Disulfiram between 1st July 2020 and 31st March 2023. Contractor/Contractor Representative Name: (please print) Signature: …………………………………………. Date: ………………….. Counter Fraud Declaration: I accept that the information provided on this form may be used to verify any claim associated with this service and may be shared with other bodies/agencies for the purposes of prevention and detection of crime. In signing this form, I consent to this use and acknowledge that if I provide false information then I may be liable to criminal prosecution, referral to my professional body and/or recovery proceedings. Please sign this document and retain for your own records. Please submit a copy as above. This document should be signed at the commencement of the service. NHS GG&C reserves the right to cancel the supervision element of this SLA and withdraw this service following a 3 month period of notice. Contractors agreeing to provide the service may cease provision following a three month notice period. Signed on behalf of NHS Greater Glasgow & Xxxxx: Contracts Manager

Agreement to Provide. Supply and pharmaceutical care as defined in the SLA and the Service Outline – Additional Pharmaceutical Services – Disulfiram Palliative Care between 1st July 2020 April 2019 and 31st March 20232021. Contractor/Contractor Representative Name: (please Please print) Signature: …………………………………………. Date: ………………….. Counter Fraud Declaration: I accept that the information provided on this form may be used to verify any claim associated with this service and may be shared with other bodies/agencies for the purposes of prevention and detection of crime. In signing this form, I consent to this use and acknowledge that if I provide false information then I may be liable to criminal prosecution, referral to my professional body and/or recovery proceedings. Please sign this document and retain for your own records. Please submit a copy as above. This document should be signed at the commencement of the service. NHS GG&C reserves the right to cancel the supervision element of this SLA and withdraw this service following a 3 month period of notice. Contractors agreeing to provide the service may cease provision following a three month notice period. Signed on behalf of NHS Greater Glasgow & Xxxxx: Contracts Manager

Agreement to Provide. Supply and pharmaceutical care as defined in the SLA and the Service Outline – Additional Pharmaceutical Care Services – Disulfiram Pharmaceutical Care for Patients Prescribed Opioid Substitution Therapy (OST) patients between 1st July 2020 April 2019 and 31st March 2023. Contractor/Contractor Representative Name: (please print) Signature: …………………………………………. Date: ………………….. Counter Fraud Declaration: I accept that the information provided on this form may be used to verify any claim associated with this service and may be shared with other bodies/agencies for the purposes of prevention and detection of crime. In signing this form, I consent to this use and acknowledge that if I provide false information then I may be liable to criminal prosecution, referral to my professional body and/or recovery proceedings. Please sign this document and retain for your own records. Please submit a copy as above. This document should be signed at the commencement of the service. NHS GG&C reserves the right to cancel the supervision element of this SLA and withdraw this service following a 3 month period of notice. Contractors agreeing to provide the service may cease provision following a three month notice period. Signed on behalf of NHS Greater Glasgow & Xxxxx: Contracts Manager

Agreement to Provide. Supply and pharmaceutical care as defined in the SLA and the Service Outline – Additional Pharmaceutical Care Services – Disulfiram Pharmaceutical Care for Patients Prescribed Opioid Substitution Therapy (OST) patients between 1st July 2020 April 2019 and 31st March 20232022. Contractor/Contractor Representative Name: (please print) Signature: …………………………………………. Date: ………………….. Counter Fraud Declaration: I accept that the information provided on this form accurately reflects activity during the timescale described. I further accept that the information provided may be used to verify any claim associated with this service calculate future payment levels and may be shared with other bodies/agencies for the purposes of prevention and detection of crimecrime and future service planning. In signing this form, I consent to this use and acknowledge that if I provide false information then I may be liable to criminal prosecution, referral to my professional body and/or recovery proceedings. Please sign this document and retain for your own records. Please submit a copy as above. This document should be signed at the commencement of the service. NHS GG&C reserves the right to cancel the supervision element of this SLA and withdraw this service following a 3 month period of notice. Contractors agreeing to provide the service may cease provision following a three month notice period. Signed on behalf of NHS Greater Glasgow & Xxxxx: Contracts Manager

Agreement to Provide. Supply and pharmaceutical care as defined in the SLA and the Service Outline – Additional Pharmaceutical Care Services – Disulfiram Pharmaceutical Care for Patients Prescribed Opioid Substitution Therapy (OST) patients between 1st July 2020 April 2019 and 31st March 20232022. Contractor/Contractor Representative Name: (please print) Signature: …………………………………………. Date: ………………….. Counter Fraud Declaration: I accept that the information provided on this form may be used to verify any claim associated with this service and may be shared with other bodies/agencies for the purposes of prevention and detection of crime. In signing this form, I consent to this use and acknowledge that if I provide false information then I may be liable to criminal prosecution, referral to my professional body and/or recovery proceedings. Please sign this document and retain for your own records. Please submit a copy as above. This document should be signed at the commencement of the service. NHS GG&C reserves the right to cancel the supervision element of this SLA and withdraw this service following a 3 month period of notice. Contractors agreeing to provide the service may cease provision following a three month notice period. Signed on behalf of NHS Greater Glasgow & Xxxxx: Contracts Manager

Agreement to Provide. Supply and pharmaceutical care as defined in the SLA and the Service Outline – Additional Pharmaceutical Services – Disulfiram between 1st July 2020 and 31st March 20232022. Contractor/Contractor Representative Name: (please print) Signature: …………………………………………. Date: ………………….. Counter Fraud Declaration: I accept that the information provided on this form may be used to verify any claim associated with this service and may be shared with other bodies/agencies for the purposes of prevention and detection of crime. In signing this form, I consent to this use and acknowledge that if I provide false information then I may be liable to criminal prosecution, referral to my professional body and/or recovery proceedings. Please sign this document and retain for your own records. Please submit a copy as above. This document should be signed at the commencement of the service. NHS GG&C reserves the right to cancel the supervision element of this SLA and withdraw this service following a 3 month period of notice. Contractors agreeing to provide the service may cease provision following a three month notice period. Signed on behalf of NHS Greater Glasgow & Xxxxx: Contracts Manager

Agreement to Provide. Supply and pharmaceutical care as defined in the SLA and the Service Outline – Additional Pharmaceutical Care Services – Disulfiram Pharmaceutical Care for Patients Prescribed Opioid Substitution Therapy (OST) patients between 1st July 2020 April 2019 and 31st March 20232024. Contractor/Contractor Representative Name: (please print) Signature: …………………………………………. Date: ………………….. Counter Fraud Declaration: I accept that the information provided on this form may be used to verify any claim associated with this service and may be shared with other bodies/agencies for the purposes of prevention and detection of crime. In signing this form, I consent to this use and acknowledge that if I provide false information then I may be liable to criminal prosecution, referral to my professional body and/or recovery proceedings. Please sign this document and retain for your own records. Please submit a copy as above. This document should be signed at the commencement of the service. NHS GG&C reserves the right to cancel the supervision element of this SLA and withdraw this service following a 3 month period of notice. Contractors agreeing to provide the service may cease provision following a three month notice period. Signed on behalf of NHS Greater Glasgow & Xxxxx: Contracts Manager