PRODUCER AGREEMENTProducer Agreement • November 16th, 2018 • Colorado
Contract Type FiledNovember 16th, 2018 JurisdictionROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION, INC.,a Colorado corporation d/b/a Rocky Mountain Health Plans (herein “RMHP”) print/type name of contracting entity(herein “Producer”) 2775 Crossroads Boulevard Post Office Box 10600Grand Junction, CO 81502-5600 Physical Address of Producer: Mailing Address of Producer, if different from above: Telephone Number: Alternate Telephone Number: Fax Number: Email Address: Tax I.D. No.: Producer License No.: