Provider Enrollment AgreementProvider Enrollment Agreement • July 7th, 2015
Contract Type FiledJuly 7th, 2015(hereinafter the “Provider”) wishes to participate in the Connecticut Medical Assistance Program. For purposes of this Provider Enrollment Agreement (hereinafter the “Agreement”), the term “Connecticut Medical Assistance Program” means any and all of the health benefit programs administered by the State of Connecticut Department of Social Services (hereinafter “DSS”). The Provider represents and agrees as follows: