THIS IS A COPY OF HE ALLIANCE HEALTH PROFESSIONAL PROVIDER CONTRACT TEMPLATE, IT IS PROVIDED FOR REVIEW ONLY AND IS NOT FORMATTED FOR SIGNATURESNorth Carolina • September 27th, 2023
Jurisdiction FiledSeptember 27th, 2023(“Contract”) is made and entered into by and between Alliance Health, a political subdivision of the State of North Carolina and Prepaid Inpatient Health Plan (hereinafter referred to as “Alliance” or “PIHP”), and the Provider listed below (hereinafter referred to as “Provider” or “Participating Provider”), also individually referred to as “Party” and collectively as “Parties”, for Provider’s provision of Medicaid Covered health care items and Services to Alliance’s Medicaid Direct Members.