TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. Xxxx Xxxxx, Program Manager DHSS Division of Behavioral Health 0000 X Xxxxxx Xxxxx 000 Anchorage, Alaska 99503-5935 Ph (000) 000-0000/FX (000) 000-0000 PO Box 110650 Juneau, AK 99811-0650
TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non-payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice. The State is liable only for payment in accordance with the payment provision of this Provider Agreement for relief nursing services rendered before the effective date of termination. This agreement shall be in effect as soon as the agreement is signed by both parties to the agreement. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Xxxxxxxx Xxxxxx, Program Manager Alaska Psychiatric Institute 0000 Xxxxx Xxxxxx Anchorage, AK 99508 xxxxxxxx.xxxxxx@xxxxxx.xxx Xxxxxx Xxxxx, Xxxxxx Administrator Grants & Contracts Juneau, AK 99811-0650 Ph. 000-000-0000 Fax 000- 000-0000 Provider’s Federal Tax ID Number xxxxxx.xxxxx@xxxxxx.xxx
TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non-payment and automatic termination of the Agreement by DHSS.
TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. The Parties will collaborate in good faith to attempt to remedy any issues that might result in the termination of this Agreement. Notification of non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non-payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Xxxxxx Xxxxxx, Tribal Title IV-E Program Coordinator Office of Children’s Services P.O. Box 110630 Juneau, Alaska 00000-0000 Phone: 000-000-0000 Fax: 000-000-0000 Xxxxxx Xxxxxx-Xxxxxxxx, Grants Administrator P.O. Box 110650 Juneau, AK 00000-0000 Phone: 000-000-0000 Fax: 000-000-0000 Signed provider agreements and documents demonstrating provider eligibility must be emailed to: XXX.XXX.Xxxxxx.Xxxxxxxx.Xxxxxxxxxx@xxxxxx.xxx.
TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DFCS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of ineligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non-payment and automatic termination of the Agreement by DFCS.
TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify FCS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non- eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non- payment and automatic termination of the Agreement by FCS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, FCS may terminate this Agreement with 30 days’ notice. A Provider may also terminate the Agreement with 30 days’ notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Provider assigned practitioners, as directed by FCS. This Agreement remains in force until the Provider or FCS terminates the Agreement or a material term of the Agreement is changed. PROVIDER DEPT OF FAMILY & COMMUNITY SERVICES Alaska Psychiatric Institute Attn: API Contracts Office 0000 Xxxxx Xxxxxx Anchorage, AK 99508-3700 xxx.xxx.xxxxxxxxx@xxxxxx.xxx Family and Community Services P.O. Box 112650 Fax (000) 000-0000
TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non-payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days notice. A Provider may also terminate the Agreement with 30 days notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. The notice must include the date on which the Provider will cease to provide BCHC Consultant/Resource services. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. PROVIDER DEPT. OF HEALTH & SOCIAL SERVICES Xxxxxx Xxxxxxx, BCHC Program Director Division of Public Health 000 “X” Xxxxxx, Xxxxx 000 Anchorage, AK 99503 Phone: (000) 000-0000 / Fax: (000) 000-0000 Xxxxx Xxxxxx, Grants Administrator Grants & Contracts Support Team PO Box 110650 Phone: (000) 000-0000 / Fax: (000) 000-0000
TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non-payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200 (Request for Appeal). All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days notice. A Provider may also terminate the Agreement with 30 days notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed. Provider Name: Xxxxx # Provider Address: Street / PO City State Zip Provider Federal Tax ID #: Provider Phone #: Provider Fax # I certify that I am authorized to negotiate, execute and administer this agreement on behalf of the Provider agency named in this agreement, and hereby consent to the terms and conditions of this agreement, and its appendices and attachments. PROVIDER: Signature of Provider Authorized Representative Printed Name of Authorized Provider Representative Title of Authorized Provider Representative Date
TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify the department immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its
TERMINATION OF AGREEMENT AND APPEALS. The Provider agrees to notify DHSS immediately if it is no longer eligible to provide services based on applicable Provider eligibility requirements set out in Section I of this Agreement. Notification of non-eligibility will result in automatic termination of this Agreement. Failure to comply with the terms of this Agreement and/or standards outlined in the Agreement and its appendices may result in non-payment and automatic termination of the Agreement by DHSS. A Provider may appeal the decision to terminate a Provider Agreement under 7 AAC 81.200. All appeals will be conducted in accordance with Section 7AAC 81.200-210 of the Alaska Administrative Code. Except as noted above, DHSS may terminate this Agreement with 30 days notice. A Provider may also terminate the Agreement with 30 days notice, but must provide assistance in making arrangements for safe and orderly transfer of clients and information to other Providers, as directed by DHSS. This Agreement remains in force until the Provider or DHSS terminates the Agreement or a material term of the Agreement is changed.
