Common Contracts

DRUG MEDI-CAL PROVIDER AGREEMENT

Drug Medi-Cal Provider Agreement • May 25th, 2020 • California

• Contract Type
  Drug Medi-Cal Provider Agreement
• Filed
  May 25th, 2020
• Jurisdiction
  California

Date Legal name of applicant or provider Business name (if different than legal name) Provider number (NPI) Business telephone number( ) Business address (number, street) City State ZIP code (nine-digit) Mailing address (number, street, P.O. Box number) City State ZIP code (nine-digit) Previous business address (number, street) City State ZIP code (nine-digit)

DRUG MEDI-CAL PROVIDER AGREEMENT

Drug Medi-Cal Provider Agreement • August 18th, 2015 • California

• Contract Type
  Drug Medi-Cal Provider Agreement
• Filed
  August 18th, 2015
• Jurisdiction
  California

Date Legal name of applicant or provider Business name (if different than legal name) Provider number (NPI) Business telephone number( ) Business address (number, street) City State ZIP code (nine-digit) Mailing address (number, street, P.O. Box number) City State ZIP code (nine-digit) Previous business address (number, street) City State ZIP code (nine-digit)

DRUG MEDI-CAL PROVIDER AGREEMENT

Drug Medi-Cal Provider Agreement • July 3rd, 2015 • California

• Contract Type
  Drug Medi-Cal Provider Agreement
• Filed
  July 3rd, 2015
• Jurisdiction
  California

Date Legal name of applicant or provider Business name (if different than legal name) Provider number (NPI) Business telephone number( ) Business address (number, street) City State ZIP code (nine-digit) Mailing address (number, street, P.O. Box number) City State ZIP code (nine-digit) Previous business address (number, street) City State ZIP code (nine-digit)