BLUE CROSS BLUE SHIELD OF MICHIGAN AMBULATORY SURGERY FACILITY PARTICIPATION AGREEMENTAmbulatory Surgery Facility Participation Agreement • July 4th, 2022 • Michigan
This Agreement by and between Blue Cross Blue Shield of Michigan (BCBSM), a nonprofit health care corporation, and the undersigned Ambulatory Surgical Facility (Provider), that is duly licensed under applicable state law to conduct business, and whose tax name, business name (or DBA) and primary site address are listed on the accompanying Signature Document, and whose additional approved sites, if applicable, are listed on Addendum H. Pursuant to this Agreement, BCBSM and Provider agree as follows:
BCBSM AMBULATORY SURGERY FACILITY PARTICIPATION AGREEMENT SIGNATURE DOCUMENTAmbulatory Surgery Facility Participation Agreement • September 8th, 2021
IN WITNESS WHEREOF, the Provider wishing to be bound by the terms and conditions of the BCBSM Ambulatory Surgery Facility Participation Agreement (WP 12861 AUG 10) (Agreement) has affixed its signature to this Signature Document which is incorporated by reference in the Agreement.
