Common Contracts

Contract

Provider Agreement • June 15th, 2021 • Florida

• Contract Type
  Provider Agreement
• Filed
  June 15th, 2021
• Jurisdiction
  Florida

THIS FLORIDA MEDICAID PROGRAM ADDENDUM (the “Addendum”) is intended to supplement the Provider Agreement (the “Agreement”) entered into by and between LIBERTY Dental Plan of Florida, Inc. (“LIBERTY”) and the legal entity or individual qualified and licensed to practice dentistry in the state of Florida as defined in the Agreement and as specified on the signature page of this Addendum (“Dentist” or “Provider”) (together, the “Parties”). This Addendum is intended to set forth the requirements governing the relationship between the Parties, Payors, and the State of Florida Agency for Health Care Administration (the “Agency” or “AHCA”) with respect to the provision of Medicaid services to Members. Except as expressly modified by this Addendum, the Agreement remains in full force and effect and all capitalized terms in this Addendum (which are not otherwise defined) shall have the meaning ascribed to them in the Agreement. All rights granted to and obligations imposed upon Dentist hereunde