Provider Agreement. I declare that I have read and understood the requirements as stated in this document and I agree to comply with these requirements. I further declare that all of the information I have provided on this form is true and correct to the best of knowledge. I agree to notify the county within 10 calendar days if any of the information I have provided in this Provider Workweek and Travel time Agreement changes, and depending on what information has changed, I may be required to complete a new SOC 2255. PROVIDER SIGNATURE: DATE: PROVIDER’S PRINTED NAME: FOR COUNTY USE ONLY WORKER NAME: DATE: ESTIMATED TRAVEL TIME REVIEWED: YES n NO n SOURCE USED TO VERIFY TRAVEL TIME:
Provider Agreement. The department may refuse to enter into or may revoke the Child Care Assistance Provider Agreement, Form 470-3871 or 470-3871(S), if any of the following occur:
Provider Agreement a written agreement between a provider as defined under of this Article and the PACE organization or a subcontractor to provide services to the PACE organization's members.
Provider Agreement. The client and the provider shall enter into an agreement, using Form 470-0636, Provider Agreement, prior to the provision of service. Any reduction to the state supplemental assistance program shall be applied to the maximum amount paid by the department of human services as stated in the Provider Agreement by using Form 470-1999, Amendment to Provider Agreement.
Provider Agreement a written agreement between a provider and the MCO or a subcontractor to provide services to the MCO's members.
Provider Agreement. I agree to:
Provider Agreement. Those agreements between Company and Providers for the provision of Internet text searching capabilities, comparison shopping capabilities, contextual advertisements, or banner advertisements through Programs.
Provider Agreement. The Provider must have in effect a written Provider Agreement with the Department that has been properly executed and is in effect.
Provider Agreement. The provider participation agreement between Humana and Hospital to serve Humana’s Members. This Attachment is attached to the Agreement. For purposes of this Attachment, “affiliate” means, when used with reference to a specific Humana Inc. organization, directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with Humana Inc. Under this Agreement, Humana Wisconsin Health Organization Insurance Corporation is an affiliate and licensee of the Oklahoma Insurance Department authorized to transact business within the State of Oklahoma.
Provider Agreement. An agreement between Vendor and a Participating Provider that sets forth the terms and conditions under which the Participating Provider participates in one or more of Vendor’s networks of providers.
