Common Contracts
1 similar null contracts
ContractSeptember 1st, 2023
PROVIDER AGREEMENT To receive publicly funded vaccines at no cost, I agree to the following conditions, on behalf of myself and all the practitioners, nurses, and others associated with the health care facility of which I am the medical director or practice administrator or equivalent: 1. I will submit a provider profile representing populations served by my practice/facility. I will submit more frequently if 1) the number of patients served changes or 2) the status of the facilitychanges during the calendar year. 2. I will screen patients and document eligibility status at each immunization encounter and administer Bridge Access Program vaccines only to adults who are at least 19 years of age and meet one of the following categories:a) Uninsured: A person who does not have health insurance.b) Underinsured: A person who has health insurance, but the insurance does not include any vaccines; a person whose insurance covers only selected vaccines; a person whose insurance does not prov
