Common Contracts
4 similar Business Associate Agreement contracts
CONTRACT FOR CRP Services DPHHS Insert Contract NumberBusiness Associate Agreement • September 8th, 2023 • Montana
THIS CONTRACT, is entered into between the Montana Department of Public Health and Human Services, (the "Department"), whose contact information is as follows: Insert Address, lnsert City, MT, lnsert Zip Code, and Phone Number (406) lnsert Phone Number, and Fax Number (406) lnsert Fax Number, and lnsert Contractor Name (the “Contractor”), whose contact information is as follows: Federal Tax ID lnsert Federal Tax ID Number , UEI Number, Insert UEI Number, lnsert Street Address, lnsert City, Insert State, lnsert Zip Code, Phone Number lnsert Phone Number, and Fax Number lnsert Fax Number; respectively (collectively, the “Parties”).
CONTRACT NUMBER Insert Contract NumberBusiness Associate Agreement • June 21st, 2023 • Montana
THIS CONTRACT, is entered into between the Montana Department of Public Health and Human Services, (the "Department"), whose contact information is as follows: PO Box 4210, Helena, MT, 59604- 4210, and Phone Number (406) 655-7673, and Fax Number (406) 652-1781, and lnsert Contractor Name (the “Contractor”), whose contact information is as follows: Federal Tax ID lnsert Federal Tax ID Number
CONTRACT NUMBER Insert Contract NumberBusiness Associate Agreement • July 11th, 2022 • Montana
THIS CONTRACT, is entered into between the Montana Department of Public Health and Human Services, (the "Department"), whose contact information is as follows2121 Rosebud Drive Suite C, Billings, MT, 59102, and Phone Number (406) 655-7673, Email lacey.conzelman@mt.gov and Fax Number (406) 652-1781, and lnsert Contractor Name (the “Contractor”), whose contact information is as follows: Federal Tax ID lnsert Federal Tax ID Number , UEI Number lnsert DUNS Number, lnsert Street Address, lnsert City, Insert State, lnsert Zip Code, Phone Number lnsert Phone Number, and Fax Number lnsert Fax Number; respectively (collectively, the “Parties”).
CONTRACT NUMBER Insert Contract NumberBusiness Associate Agreement • November 30th, 2020 • Montana
THIS CONTRACT, is entered into between the Montana Department of Public Health and Human Services, (the "Department"), whose contact information is as follows: Insert Address, lnsert City, MT, lnsert Zip Code, and Phone Number (406) lnsert Phone Number, and Fax Number (406) lnsert Fax Number, and lnsert Contractor Name (the “Contractor”), whose contact information is as follows: Federal Tax ID lnsert Federal Tax ID Number , DUNS Number lnsert DUNS Number, lnsert Street Address, lnsert City, Insert State, lnsert Zip Code, Phone Number lnsert Phone Number, and Fax Number lnsert Fax Number; respectively (collectively, the “Parties”).
