Common Contracts
2 similar Participating Provider Agreement contracts
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • November 8th, 2021
I, the undersigned (hereinafter referred to as "Provider" or "Contractor"), duly certified and participating in both the state Medicaid Program and the Federal Medicare Program, and, as applicable, duly licensed under the laws of the Commonwealth of Pennsylvania, in consideration of being enrolled by the Pennsylvania Department of Health, Chronic Renal Disease Program (hereinafter referred to as "Department" or "CRDP"), as a participating provider, do hereby agree to be legally bound as follows: I offer to and shall provide special health services pursuant to this Agreement for the Department to CRDP-eligible individuals in accordance with the restrictions indicated on the individual's CRDP identification card, make reports to the Department concerning such services, and accept compensation therefore in accordance with the terms and conditions stated or incorporated in this Agreement. This Agreement is effective as of
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • February 24th, 2021
I, the undersigned (hereinafter referred to as "Provider" or "Contractor"), duly certified and participating in both the state Medicaid Program and the Federal Medicare Program, and, as applicable, duly licensed under the laws of the Commonwealth of Pennsylvania, in consideration of being enrolled by the Pennsylvania Department of Health, Chronic Renal Disease Program (hereinafter referred to as "Department" or "CRDP"), as a participating provider, do hereby agree to be legally bound as follows: I offer to and shall provide special health services pursuant to this Agreement for the Department to CRDP-eligible individuals in accordance with the restrictions indicated on the individual's CRDP identification card, make reports to the Department concerning such services, and accept compensation therefore in accordance with the terms and conditions stated or incorporated in this Agreement. This Agreement is effective as of
