LIBERTY DENTAL PLAN OF FLORIDA, INC. PROVIDER AGREEMENTLiberty Dental • November 9th, 2020 • Florida
THIS FLORIDA MEDICAID PROGRAM ADDENDUM (the “Addendum”) is intended to supplement the Provider Agreement (the “Agreement”) entered into by and between LIBERTY Dental Plan of Florida, Inc. (“LIBERTY”) and the legal entity or individual qualified and licensed to practice dentistry in the State of Florida as defined in the Agreement (“Dentist” or “Provider”) (together, the “Parties”). This Addendum is intended to set forth the requirements governing the relationship between the Parties and the Florida Agency for Health Care Administration (the “Agency” or “AHCA”) with respect to the provision of Medicaid dental services to Enrollees, as defined herein. Except as expressly modified by this Addendum, the Agreement remains in full force and effect and all capitalized terms in this Addendum (which are not otherwise defined) shall have the meaning ascribed to them in the Agreement. This Addendum shall become effective as of the date Dentist is approved by LIBERTY to provide services to Enrolle
