Common Contracts
3 similar null contracts
DRUG MEDI-CAL PROVIDER AGREEMENTCalifornia • May 25th, 2020
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 AGREEMENTCalifornia • August 18th, 2015
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 AGREEMENTCalifornia • July 3rd, 2015
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)
