Sample Practice Participation Agreement Cover LetterPractice Participation Agreement • December 31st, 2018
Contract Type FiledDecember 31st, 2018Letter to include: practice name, practice address, physician champion, practice leadership person, application key contact name of person responsible for project implementation, email address, and phone. If a multi-site practice, indicate physician champion and IBH practice team at each site. Letter is to be signed by all members of the IBH implementation team