Non-Physician Provider NETWORK PARTICIPATION AGREEMENTNetwork Participation Agreement • September 23rd, 2014 • Idaho
Contract Type FiledSeptember 23rd, 2014 JurisdictionThis Network Participation Agreement (“Agreement”) is by and between Portneuf Quality Alliance (“PQA”) and (insert name of PROVIDER, or if GROUP PRACTICE, insert the legal name of the Group Practice). If this Agreement is with a Provider, the term “Provider Practice” shall refer to the Provider. If this Agreement is with a Provider Group Practice, the term “Provider Practice” shall refer collectively to the Group Practice and each of its providers who have signed Exhibit A of this Agreement.