Blue MedicareRxSM Referral Program PRODUCER PARTICIPATION AGREEMENTSeptember 8th, 2009
FiledSeptember 8th, 2009This form is to be completed by licensed producers who are contracted and appointed with Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas. If you are a subagent wanting to participate in the Producer Referral Program, the principal of your Agency must complete this form first and you, the subagent, must complete the participation form specifically for subagents. Your participation will not be active until the Agency principal completes this form and identifies