Sample Practice Participation Agreement Cover LetterPractice Participation Agreement • December 31st, 2018
Letter to include: practice name, practice address, physician champion, practice leadership person, application key contact name of person responsible for project implementation, email address, and phone. If a multi-site practice, indicate physician champion and IBH practice team at each site. Letter is to be signed by all members of the IBH implementation team
FIRST COAST HEALTH ALLIANCE, LLC PRACTICE PARTICIPATION AGREEMENTPractice Participation Agreement • November 18th, 2013 • Florida
THIS PRACTICE PARTICIPATION AGREEMENT (the “Agreement”) is effective the day of , 2013 (the “Effective Date”), between and among FIRST COAST HEALTH ALLIANCE, LLC (“FCHA”), and
Sample Practice Participation Agreement Cover LetterPractice Participation Agreement • January 11th, 2021
Letter to include: practice name, practice address, physician champion, practice leadership person, application key contact name of person responsible for project implementation, email address, and phone. If a multi-site practice, indicate physician champion and IBH practice team at each site. Letter is to be signed by all members of the IBH implementation team
