SUBCONTRACTOR ENROLLMENT AGREEMENTAging and Adult Services • August 27th, 2018
Contract Type FiledAugust 27th, 2018This form is to be completed by all providers who wish to receive payment for the Medicaid-enrolled PRE-PAID AMBULATORY HEALTH PLAN for services provided the Home & Community Based Services for the Elderly & Disabled. An original payment agreement must be submitted for each business location and for each eligible person.