FORM OF ELIGIBILITY SCREENING SERVICES AGREEMENTForm of Eligibility Screening Services Agreement • December 4th, 2015 • Quorum Health Corp • Services-general medical & surgical hospitals, nec • Tennessee
Contract Type FiledDecember 4th, 2015 Company Industry JurisdictionThis Services Agreement (this “Agreement”) entered into this 1st day of , 2016 by and between Eligibility Screening Services, LLC, a Delaware limited liability company (“Vendor”), and QHCCS, LLC, a Delaware limited liability company (“Client”).