Instructions/annotation for preparation of this contract:Provider Service Contract • February 19th, 2009
Lines “ ” are provided to be filled in with names, addresses, procedures, etc. Square brackets “ [ ]” denote material that needs to be deleted, modified, or added to.
Instructions/annotation for preparation of this contract renewal:Provider Service Contract • February 19th, 2009
Lines “ ” are provided to be filled in with names, addresses, procedures, etc. Square brackets “ [ ]” denote material that need to be deleted, modified, or added to.
PROVIDER SERVICE CONTRACTProvider Service Contract • July 24th, 2020 • California
This Agreement is made and entered into, as of the Effective Date described below, by and between [Provider Organization], a California nonprofit public benefit corporation hereafter referred to as [dba name], [street address, city, state, zip code] and the health care provider (the “Contractor”) named on the “Service Description/Negotiated Terms & Variations/Signature Page” (the “Signature Page”) attached hereto and incorporated herein by this reference.
