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Ancillary Services Provider Agreement Sample Contracts

Ancillary Services Provider Agreement Modification Notice
Ancillary Services Provider Agreement • July 6th, 2021

The purpose of this letter is to inform you that pursuant to the terms of your Ancillary Services Provider Agreement (“Agreement”), AmeriHealth Caritas North Carolina, Inc. (“ACNC”) is modifying your Agreement as follows:

Standard Contracts

ANCILLARY SERVICES PROVIDER AGREEMENT
Ancillary Services Provider Agreement • September 20th, 2012

and entered into as of the effective date set forth on the signature page below (“Effective Date”), by and between (“Provider”) and Granite State Health Plan, Inc. (“MCO”).