INLAND EMPIRE FOUNDATION FOR MEDICAL CARE ANCILLARY PROVIDER MEMBERSHIP AGREEMENTAncillary Provider Membership Agreement • October 24th, 2019
of this day of , 20 by and between the UFMC HEALTH SYSTEMS, INC. dba INLAND EMPIRE FOUNDATION FOR MEDICAL CARE ("IEFMC"), a corporation organized under the laws of the State of California, and (PROVIDER). This Agreement is not effective until PROVIDER has completed the IEFMC application and submitted supporting documentation to IEFMC, and PROVIDER has received a letter from the IEFMC approving PROVIDER's application.
