UNITED BEHAVIORAL HEALTH INDIVIDUAL PARTICIPATING PROVIDER AGREEMENTBehavioral Health Individual Participating Provider Agreement • September 8th, 2011
Contract Type FiledSeptember 8th, 2011THIS AGREEMENT is between United Behavioral Health ("UBH") and the undersigned provider (hereinafter referred to as the "Provider"). This Agreement will become effective upon the date set forth in UBH’s executed Acceptance Letter (the "Effective Date"). This Agreement sets forth the terms and conditions under which Provider shall participate in one or more networks developed by UBH as a Participating Provider of Covered Services to Members.
UNITED BEHAVIORAL HEALTH INDIVIDUAL PARTICIPATING PROVIDER AGREEMENTBehavioral Health Individual Participating Provider Agreement • September 8th, 2011
Contract Type FiledSeptember 8th, 2011THIS AGREEMENT is between United Behavioral Health ("UBH") and the undersigned provider (hereinafter referred to as the "Provider"). This Agreement will become effective upon the date set forth in UBH’s executed Acceptance Letter (the "Effective Date"). This Agreement sets forth the terms and conditions under which Provider shall participate in one or more networks developed by UBH as a Participating Provider of Covered Services to Members.