ANCILLARY PROVIDER AFFILIATION AGREEMENT SIGNATURE PAGEAncillary Provider Affiliation Agreement • July 24th, 2020
IN WITNESS WHEREOF, the parties wishing to be bound by the terms and conditions of the Blue Cross Complete of Michigan Ancillary Provider Affiliation Agreement (NOV2012) have affixed their signature on this Signature Document, which is incorporated by reference in the Blue Cross Complete of Michigan Ancillary Provider Affiliation Agreement. The Agreement effective date will be established by Blue Cross Complete of Michigan (BCC) and documented on the original counter-signed Agreement returned to the Provider upon completion of the affiliation process.
BLUE CROSS COMPLETE OF MICHIGAN ANCILLARY PROVIDER AFFILIATION AGREEMENTAncillary Provider Affiliation Agreement • January 29th, 2022 • Michigan
This Agreement is effective (Date to be entered only by Health Plan) for an initial term through the end of the calendar year. The Agreement shall renew automatically for additional one-year terms unless otherwise terminated as provided below.
ANCILLARY PROVIDER AFFILIATION AGREEMENTAncillary Provider Affiliation Agreement • January 30th, 2022 • Michigan
This Agreement is made between Blue Care Network of Michigan, Blue Care of Michigan, Inc. and BCN Service Company (hereinafter collectively referred to as Health Plan) and (hereinafter referred to as Provider).
