Clinical Integration Organization NETWORK PARTICIPATION AGREEMENTNetwork Participation Agreement • September 23rd, 2014 • Idaho
Contract Type FiledSeptember 23rd, 2014 JurisdictionThis Network Participation Agreement (“Agreement”) is by and between Portneuf Quality Alliance (“PQA”) and (insert name of INDIVIDUAL PHYSICIAN, or if GROUP PRACTICE, insert the legal name of the Group Practice). If this Agreement is with an individual Physician, the term “Physician Practice” shall refer to the physician. If this Agreement is with a physician Group Practice, the term “Physician Practice” shall refer collectively to the Group Practice and each of its physicians who have signed Exhibit A of this Agreement.