Common use of Significant Business Transactions Clause in Contracts

Significant Business Transactions. Subcontractors: Has the Provider Entity had any Significant Business Transactions with a Subcontractor totaling more than $25,000 in the past five (5) year period? Yes No-Skip to #11 N/A-Skip to #11 If yes, list the information for Subcontractors with whom the Provider Entity had any Significant Business Transactions exceeding the $25,000 during the past 5-year period (42 CFR §455.105(b)(2)). Attach additional sheets as necessary - Yes No Name of Subcontractor:   Subcontractor’s SSN or TIN:   Subcontractor Address:   City, State, Zip:   Subcontractors Owner (SO):   SO’s SSN or TIN:   SO’s Address:   City, State, Zip:   This Section (VI) is not required to be completed at this time; however, this information must be provided and/or updated within 35 days of a request. Medicaid payments may be denied for services furnished during the period beginning on the day following the date the information was due until it is received (42 CFR §455.105)

Significant Business Transactions. Subcontractors: Has the Provider Entity had any Significant Business Transactions with a Subcontractor totaling more than $25,000 in the past five (5) year period? Yes No-Skip to #11 N/A-Skip to #11 If yes, list the information for Subcontractors with whom the Provider Entity had any Significant Business Transactions exceeding the $25,000 during the past 5-year period (42 CFR §455.105(b)(2)). Attach additional sheets as necessary - Yes No Name of Subcontractor:   Subcontractor’s SSN or TIN:   Subcontractor Address:   City, State, Zip:   Subcontractors Owner (SO):   SO’s SSN or TIN:   SO’s Address:   City, State, Zip:   This Section (VI) is not required to be completed at this time; however, however this information must be provided and/or updated within 35 days of a request. .. Medicaid payments may be denied for services furnished during the period beginning on the day following the date the information was due until it is received (42 CFR §455.105)